Ventilator-associated pneumonia: the biomedical scientist's perspective
Cardiff Metropolitan University
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Objective: To thoroughly research the subject of ventilator-associated pneumonia (VAP), it's consequences for patients, considerations for clinicians and the impact on the microbiology laboratory. This project aims to address as many of the questions biomedical science staff have when faced with the mass of respiratory samples originating from their intensive care unit and their importance to the health of the patient. The practical element of this project seeks merely to relate current practice at Nevill Hall Hospital in Abergavenny, a small district general hospital, with that in the literature, to compare organisms isolated and to investigate the significance of direct microscopy on endotracheal aspirates. Methods: A computerised Medline search on the subject of VAP covering the period 1980 to 2004. The routine endotracheal suction collections of respiratory secretions, received by the laboratory, were further tested to obtain microscopic and quantitative culture results. Results: Of the 39 patients whose specimens were tested, 25 produced specimens with organism counts of >10*6 cfu/ml, the level accepted in the literature as being indicative of VAP in endotracheal aspirate specimens. In two cases the results indicated an early-onset VAP. Of the 23 suspected late-onset VAP cases, the results were called into doubt by the organism isolated, namely Candida albicans. Conclusions: This work does not seek to determine the appropriateness of the use of endotracheal aspirate as a means of determining the presence/absence of VAP, that subject is adequately discussed in my research, rather to see if my results match those of other researchers. To that end it would appear that endotracheal aspirate was unable to distinguish reliably between pneumonia and tracheobronchial colonisation, which occurs in many patients within a few days of endotracheal intubation.
MSc Biomedical Sciences
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