TY - JOUR
T1 - Management of Non-Ventilated hospital acquired pneumonia
AU - Pittaway, Harriet
AU - Grudzinska, Frances
AU - Livesey, Alana
AU - Quarton, Samuel
AU - Adiga, Aditya
AU - Dosanjh, Davinder
AU - Parekh, Dhruv
PY - 2024
Y1 - 2024
N2 - Non-ventilated hospital acquired pneumonia (NV-HAP) is defined as pneumonia that develops at least 48 h after hospital admission in the non-invasively ventilated patient. Guidance in the management of NV-HAP has historically used extrapolated research from the wider field of HAP, which includes patients with the separate clinical entity of ventilator associated pneumonia (VAP), or the field of community acquired pneumonia (CAP). However, NV-HAP is being increasingly recognised as a subtype of HAP owing to its high incidence, mortality, morbidity and health-economic burden. With a wide range of underlying causative organisms, the management approach focuses on initial broad-spectrum coverage of common bacterial pathogens. If microbiological results are available, targeted treatment can be started. Throughout all phases of treatment, supportive measures must also be considered. This includes the use of physiotherapy, oxygen and ventilatory support, fluid therapy and nutritional support. Research is ongoing into novel treatments, including new antimicrobials, nebulised therapies and monoclonal antibodies. Future research would benefit from a focussed approach that aims to standardise clinical and research definitions and treats NV-HAP as a separate entity to VAP. Collection of specific data would allow for the development of risk-stratification or severity tools which have been fundamental in improving the management of other pneumonia patients, for example, the use of CURB-65 in CAP. Review of commonplace supportive measures in the NV-HAP population would also be beneficial in view of the mostly frail co-morbid population affected.
AB - Non-ventilated hospital acquired pneumonia (NV-HAP) is defined as pneumonia that develops at least 48 h after hospital admission in the non-invasively ventilated patient. Guidance in the management of NV-HAP has historically used extrapolated research from the wider field of HAP, which includes patients with the separate clinical entity of ventilator associated pneumonia (VAP), or the field of community acquired pneumonia (CAP). However, NV-HAP is being increasingly recognised as a subtype of HAP owing to its high incidence, mortality, morbidity and health-economic burden. With a wide range of underlying causative organisms, the management approach focuses on initial broad-spectrum coverage of common bacterial pathogens. If microbiological results are available, targeted treatment can be started. Throughout all phases of treatment, supportive measures must also be considered. This includes the use of physiotherapy, oxygen and ventilatory support, fluid therapy and nutritional support. Research is ongoing into novel treatments, including new antimicrobials, nebulised therapies and monoclonal antibodies. Future research would benefit from a focussed approach that aims to standardise clinical and research definitions and treats NV-HAP as a separate entity to VAP. Collection of specific data would allow for the development of risk-stratification or severity tools which have been fundamental in improving the management of other pneumonia patients, for example, the use of CURB-65 in CAP. Review of commonplace supportive measures in the NV-HAP population would also be beneficial in view of the mostly frail co-morbid population affected.
U2 - 10.1016/j.clinpr.2024.100350
DO - 10.1016/j.clinpr.2024.100350
M3 - Article
SN - 2590-1702
VL - 21
JO - Clinical Infection in Practice
JF - Clinical Infection in Practice
M1 - 100350
ER -