Hap vap hcap

Risk factors for the development of HAP fall into four general categories:

• Intubation and mechanical ventilation

• Aspiration

• Oropharyngeal colonization

• Hyperglycemia

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Intubation and mechanical ventilation increase the risk of HAP/VAP 6- to 21-fold. '

VAP may also be related to colonization of the ventilator circuit. Risk of aspiration is increased in these patients due to the supine positioning of the patient, the presence of the endotracheal tube preventing the closure of the epiglottis over the glottis, enteral

feedings, GER, and medications. Oropharyngeal colonization is affected by the use of antibiotics, oral antiseptics, and poor infection control measures, which may decrease normal commensal flora and allow pathogenic organisms to colonize the oral cavity. Hyperglycemia may directly or indirectly promote infection; two proposed mechanisms are inhibiting phagocytosis and providing additional nutrients for bacteria.

Once breakdown of the local host defenses occurs and organisms invade the lung tissue, an inflammatory response is generated either by the organisms causing tissue damage or by the immune response to the presence of the organisms. This inflammatory response either can remain localized in the infected tissue or can become systemic. The role of the alveolar macrophages is twofold. First, to engulf the organisms and to contain the infection and second to process the antigens for presentation in order to generate a specific immune response by either the cell-mediated or humoral system or both. The macrophages release cytokines in the area of the infection, which result in increased mucous production, constricting the local vasculature and lymphatic vessels, and attraction of other immune cells to the site. The increase in mucous is associated with symptoms such as cough, and sputum production. If tumor necrosis factor a (TNF-a), and interleukins 1 (IL-1) and (IL-6) are released systemically, then the symptoms become more severe and include hypotension, organ dysfunction and/ or a septic or septic-shock clinical presentation.

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