PRIYA & LEENA - PPT APRIL 2022 newgĝ.pptx

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1. VENTILATOR ASSOCIATED EVENTS VAP IN ICU AND MANAGEMENT

2. GOAL Preventing VAE in our Department Providing Excellent nursing care related to VAE Preventing Potential Complications

3. INTRODUCTION Mechanical Ventilation is an essential life, saving therapy for patients which critical illness and respiratory failure. These patients are at high risk for complications and poor outcomes, including death.

4. VENTILATOR ASSOCIATED EVENTS VAP SEPSIS ARDS PULMONARY EMBOLISM BAROTRAUMA PULMONARY EDEMA

5. These Complications are leads to longer duration of MV . Longer stay in ICU and hospitals increased health care costs and increased disability and death. VAP VAP is a type of lung infection that occurs in people who are on MV breathing machines in hospitals as such VAP is typically effects critically in persons that are in an intensive care unit and have been on a MV for 48 hours.

6. SEPSIS Any type of infection ( Bacterial , Viral , Fungal ) leads to sepsis , Infections that more commonly results in Sepsis include infections of lungs, Such as Pneumonia.

7. ARDS Acute respiratory distress syndrome is a life – threatening lung injury that allows fluid to leak in to lungs. Breathing becomes difficult and oxygen cannot get in to the body. Most people who gets ARDS are already at the hospitals for trauma or illness. .

8. PULMONARY EMBOLISM Pulmonary embolism is a blockage in one of the pulmonary arteries in lungs. In most cases , Pulmonary embolism is caused by blood clots that travel to the lungs from deep veins in the legs or rarely from veins in other parts of the body.

9. WARNING SIGNS OF PULMANORY EMBOLISM SOB CHEST PAIN A FEELING OF ANXIETY A FEELING OF DIZZINESS IRREGULAR HEART BEAT PALPITATION COUGHING OR COUGHING UP BLOOD SWEATING LIGHT HEADNESS OR FAINTING

10. PULMONARY EDEMA Pulmonary edema is a condition caused by excess fluid in the lungs. This fluid collects in the numerous are sacs in the lungs making it difficult to breath in most cause heart problems cause pulmonary edema. PULMANORY BAROTRAUMA Pulmonary Barotrauma from invasive mechanical ventilation refers to alveolar rupture due to elevated trans alveolar pressure

11. HOW WE CAN PREVENT VENTILATOR ASSOCIATED EVENTS ? POTENTIAL STRATEGIES INCLUDE :- Avoiding intubation Minimizing Sedation Paired daily spontaneous awakening and breathing trials Early Exercise and Mobility ( Chest Physio, ROM, Physiotherapy ) Low tidal volume ventilation Conservative Fluid Management Conservative blood transfusion thresholds

12. MANAGEMENT FOR VAEs Checking the Chest film ( Chest X Ray ) ABG Respiratory Cultures ( Tracheal Aspirate & Sputum Cls Selective use of CT angiograms Reduce the tidal volume 6 ML / KG ideal body WT Providing diuretics ( depends upon the hemodynamic stebility ) Antibiotic Therapy These are the most frequent interventions, that must be indivitualised for each patients with a meaning full deterioration in oxygen status.

13. VAP Ventilator associated pneumonia (VAP) is a type of lung infection that occurs in people who are on mechanical ventilation breathing machines in hospitals. As such VAP typically affects critically ill persons that are in an ICU and have been on a mechanical ventilator for atleast 48 hours. What is the most common cause of ventilator associated Pneumonia? The most common cause of ventilator associated pneumonia is micro aspiration of bacteria that colonize the oropharynx and upper airways in seriously ill pateints

14. HOW WE CAN PREVENT BACTERIAL COLONIZATION IN UPPER AIRWAYS HAND WASHING SUCTIONING ORAL CARE ANTIBIOTIC THERAPY AS PER SPUTUM CLS REPORT CLINICAL SIGNS / SYMTOMS OF VAP Purulent tracheal discharge Fever Respiratory Distress Elevated WBC Radiology change in Xray Film Presence of Micro Organism in Tractical Aspirate

15. VAP BUNDLE 5 MAJOR INTERVENTIONS Head of the bed elevation between 30 – 45 A daily “ sedation vacation “ and a readiness to wean assessment Peptic ulcer disease prophylaxis Deep vein thromposis prophylaxis Oral care with Chlorhexidine solution alteast 3 times a day . Airway clearance also included ( suctioning )

16. VAP MANAGEMENT As a nurse we receiving a patient with mechanical ventilation always assess the patient then access the ventilator. Assess the vital signs, lung sounds, respiratory status and breathing patterns Monitor skin color, particularly in the lips and nail beds Monitor the chest for bilateral chest expansion Obtain pulse oximetry reading Monitor ABG results Assess the need for suctioning and observe the type color and amount of secretions Assess ventilator settings Assess the level of water in the humidifier and the temperature of the humidification system because extremes in temperature can damage the mucosa in the airway Ensure that the alarms are set Empty the ventilator tubing when moisture collects.

17. NURSING STRATEGIES TO PREVENT VENTILATOR ASSOCIATED PNEUMONIA / VAEs Minimize ventilator exposure Provide excellent oral hygiene care Coordinate care for Subglottic suctioning Maintain Optimal Positioning and Encouraging Mobility Ensure adequate staffing

18. References :- * American Nurse today HHS Public Access * NCLEX – RN / SAUNDERS / LINDA ANNE SILVESTR / 5 th EDITION * CDC https://www.cdc.gov.pdfs