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Tuesday, May 20, 2014

The birth of ventilator associated pneumonia (VAP)?

The battle against ventilator acquired pneumonia (VAP) began around 1972.  At this time evidence began to show "the airway of mechanically ventilated patients quickly becomes colonized with gram-negative organisms." (1, page 2)

No one knew about VAP during the 1950s, a time when the wisdom and technology became available to artificially breathe for sick people.  It was first used in operating rooms to breathe for anesthetized patients, although it quickly made it's way to emergency rooms.  It was, of sorts, a revolutionary breakthrough in medicine.  

The initial theory was that the pathogens came from the equipment used, although, as the evidence started to mount, this theory was proven false.  It soon became obvious that the causative agent came from the patient by two primary processes:
  1. Bacterial colonization of the upper airway and upper digestive
  2. The subsequent aspiration into the lower airway
The medical condition described here soon became known as ventilator acquired pneumonia, also known as VAP.  In order to further study and evaluate it, a definition was needed: 
Pneumonia in patients who have been on mechanical ventilation for greater than 48 hours.
The Centers for Disease Control and Prevention continues to use this definition.  It is assumed that the patient did not have pneumonia at the time of intubation.

Since added to this definition is the following:
Pneumonia that develops within 48 hours of discharge from a location.
So even if the patient has be extubated and is presently among the general population of the hospital, the patient can still be diagnosed with VAP if the patient was on a ventilator continuously at any time during that previous 48 hours. (2, page 10)

Since 1972, much has been learned about VAP and how to treat and, mainly, prevent its occurrence.

  1. Van Hooser, Theron, "Ventilator Associated Pneumonia: Best Practice Strategies for Caregivers," 2002,, Kimberly Clark Co., accessed 4/21/14
  2. "Protocols and Definitions Device-associated Models: Ventilator Associated Pneumonia," Centers for Disease Control,, accessed 4/21/14

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