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VAP Diagnosis — FRCA Final MCQ

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EasyIntensive Care MedicineVAP DiagnosisFRCA Final

A 65-year-old man (ASA III) in ICU has been ventilated for 5 days following major abdominal surgery complicated by peritonitis. He develops a new fever (39.5°C), leucocytosis (WCC 22), purulent tracheal secretions, and a new infiltrate on CXR. The Clinical Pulmonary Infection Score (CPIS) is 8. What is the diagnosis?

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Correct answer: B — Ventilator-associated pneumonia

Ventilator-associated pneumonia (VAP) is defined as pneumonia occurring >48 hours after endotracheal intubation. The diagnosis is clinical: new/progressive pulmonary infiltrate PLUS ≥2 of: fever >38°C, leucocytosis or leucopenia, and purulent secretions. A CPIS >6 has reasonable sensitivity for VAP. Management: obtain BAL or tracheal aspirate for culture BEFORE starting empirical antibiotics, then commence appropriate antibiotics based on local antibiogram. HAP occurs >48 hours after hospital admission but is in non-intubated patients.

Reference: NICE – 2022 – NG139 Hospital-acquired pneumonia; ICS – 2023 – VAP prevention and management