Running head: CLINICAL SCENARIO FOR VENTILATOR ASSOCIATED PNEUMONIA
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CLINICAL SCENARIO FOR VENTILATOR ASSOCIATED PNEUMONIA
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CLINICAL SCENARIO FOR VENTILATOR ASSOCIATED PNEUMONIA
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A 67 year old man with a record of congestive heart failure as well as remote non-small cell lung cancer abruptly develops conciseness of breath. His original chest radiograph confirms diffuse infiltrates constant with pulmonary edema. On appearance to hospital, respiratory pain as well as hypoxemia calls for intubation and ventilator maintenance. The man is relocated to the intensive care unit and offered diuretics, sedatives in addition to ulcer prophylaxis managed through innermost venous catheter. After the ensuing four days, he bit by bit got better, the infiltrates diminished and his intensity of ventilator support steadily lessened.
On the 5th day of his admittance, he is detected to have with tachypnea, tachyrdia, hypoxemia as well as a new fever. His nurse at this point noted the comeback of a little thin, light brown discharge from his endotracheal tube. The man’s anterior chest is echoing to striking but crackles are noticed bilaterally over dependent relative lung field. The ventilator crash make cardiac auscultation complicated but the pace appears to be standard and no apparent murmurs perceived. The man has soft sacral and minor edema. A convenient chest radiograph reveals again dispersed joint opacities. The white blood cell tally at this juncture is 12000 cells. The intensive care group members concur that antibiotics should be started until further estimation. They are worried of whether the mixture of fever, hypoxemia, leukocytosis as well as a radiographic infiltrate is enough to institute an analytic of ventilator-associated pneumonia and prevent investigation for another situation leading to the patient’s decompensation.
The case of this man is an important issue for clinics given that ventilator associated pneumonia is the most widespread and deadly nosocomical illness of intensive care. It is identified to have an effect in the midst of 9% and 27% of intubated patients and increases the danger of dying as compared to similar patients diagnosed with VAP. VAP extends the duration of exposure, span of stay within the intensive care unit, full amount of hospital span of stay as well as hospitalization. In spite of its high frequency, diagnosing VAP is demanding since many circumstances in the midst of seriously ill patients generate similar clinical signs taking account of severe respiratory distress disorder, thromboembolic syndrome, alveolar hemorrhage, sepsis, congestive heart failure in addition to atelectasis. From the patient’s case study, it is apparent that regular bedside assessment together with radiographic data offers indicative but not perfect proof that VAP is either in attendance or else not present. Given the harshness of VAP as well as the occurrence of serious circumstances that can imitate VAP, clinicians are supposed to be prepared to think about further confirmation for VAP or set up another analysis. The patients fever, leukocytosis as well as radiographic infiltrate are all unclear conclusions that when considered on their own do not substantively alter the probability that VAP is at hand.
This patient’s situation raises a lot of questions related to the plan of clinical assessment of innovative drugs for the administration of Ventilator Associated Bacterial Pneumonia taking account of
1. What is the degree of the management outcome on antibacterial in patients having ventilator-associated bacterial pneumonia?
2. Does earlier antibacterial treatment prohibit patients from a medical trial?
3. What are good enough values as well as safety result assessments? What is the best method for determining them?
4. Is there any likelihood of stratifying harshness of illness with use of authorized scoring system?
5. Of grand importance, how is the analysis of bacterial pneumonia acknowledged?
Research Journal Articles
Azab, S. A., Sherbiny, H. S., Saleh, S. H., Elsaeed, W. F., Elshafiey, M. M., Siam, A. G., & … Gheith, T. (2015). Reducing ventilator-associated pneumonia in neonatal intensive care unit using “VAP prevention Bundle”: a cohort study. BMC Infectious Diseases, 15(1), 1-7. doi:10.1186/s12879-015-1062-1
Liao, Y., Tsai, J., & Chou, F. (2015). The effectiveness of an oral health care program for preventing ventilator-associated pneumonia. Nursing In Critical Care, 20(2), 89-97. doi:10.1111/nicc.12037
Philippart, F., Bouroche, G., Timsit, J., Garrouste-Orgeas, M., Azoulay, E., Darmon, M., & … null, n. (2015). Decreased Risk of Ventilator-Associated Pneumonia in Sepsis Due to Intra-Abdominal Infection. Plos ONE, 10(9), 1-15. doi:10.1371/journal.pone.0137262
