Ventilator Assosiated Pneumonia (VAP) merupakan infeksi parenkim paru pada pasien dengan ventilasi mekanis lebih dari 48 jam. VAP juga menjadi salah satu infeksi nosokomial paling umum pada pasien- pasien di ICU terutama yang membutuhkan ventilasi mekanis, infeksi ini berakibat pada tingginya mortalitas, memperlama waktu perawatan dan memperbesar biaya perawatan. Terdapat sekitar 5-40% pasien dengan ventilasi mekanis yang dilaporkan mengalami VAP setelah 2 hari perawatan, jumlah ini berbeda-beda tiap negara terkait pelaporan VAP.
HAP adalah infeksi nosokomial yang berkembang pada pasien setelah masuk rumah sakit. Pasien masuk rumah sakit dengan diagnosa non pneumonia, namun setelah perawatan kemudian bertambah diagnosa penumonia. HAP yang berkembang di ruang ICU memiliki tingkat kematian lebih tinggi dari HAP di ruang rawat inap biasa.
NV ICU-HAP adalah untuk menggambarkan pasien ICU non intubasi yang mengalami infeksi nosokomial.
VAP adalah infeksi nosokomial yang terjadi setelah pasien terpasang ventilasi mekanis
V ICU-HAP adalah pasien yang mengalami NV ICU-HAP yang kemudian dilakukan intubasi.
V-HAP adalah pasien di bangsal perawatan yang mengalami HAP yang kemudian dirujuk ke ICU untuk pemasangan ventilasi mekanis.
Tanda dan gejala Ventilator Associated Pneumonia
Pneumonia terkait ventilasi mekanis biasanya menyebabkan demam, meningkatnya sekret, meningkatnya laju pernafasan, peningkatan detak jantung, dan timbulnya hipoksemia.
Diagnosa
Diagnosa berdasarkan kriteria: presentasi klinis, berkembangnya infiltrat pada hasil radiologi, dan kultur sekret positif dari sistem pernafasan bawah serta di konfirmasi dengan kultur darah positif dengan patogen yang sama. Banyak hal untuk dapat mencurigai adanya VAP seperti, demam, leukositosis, dan penurunan oksigen. Namun adanya tanda- tanda kecurigaan klinis tetap saja mengalami kesulitan dalam diagnosa karena hal itu juga terjadi pula pada penyakit lainnya. Sebuah metode skoring sederhana yaitu Clinical Pulmonary Infection Score (CPIS) telah dikembangkan oleh Pugin dkk, untuk membantu diagnosis dari VAP.
[table “12” not found /]Prognosa
Tingkat kematian pada pasien dengan Ventilator Assosiated Pneumonia sangat tinggi, meskipun sebagian besar pasien meninggal disebabkan oleh penyakit yang mendasarinya, namun dengan adanya VAP tingkat risiko kematian menjadi lebih tinggi.
Pencegahan
Mengurangi terjadinya VAP di ICU menjadi kunci utama pengurangan angka kematian. Ada beberapa tindakan sebagai pencegahan seperti:
- head up
- sedasi dan asesment untuk weaning dan intubasi
- profilaksis stress ulcer.
- profilaksis DVT
- oral higiene dengan klorheksidin
- suction dengan close suction
Referensi
6609083
{6609083:GNQ8BMGV},{6609083:PAT3MIXC},{6609083:72UAPAFP},{6609083:MG8KQ5W3},{6609083:PC6VNWP2},{6609083:WFB8MU76}
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