University of North Carolina at Chapel Hill



VAE Group Exercise-April 19th, 2021Case Study #1Patient admitted intubated on ventilator and ECMO from outside hospital for acute RVF and pulmonary hypertension. ECMO de-cannulation on day 11 of mechanical ventilation. MV DayPeepFiO2Temp minTemp maxWBC minWBC maxQADCultures68553636.917.51978553636.814.719.88106036.436.818.620.5984036.336.81921.21084036.237.320.62211106036.53721.123.612104036.43720.726.313104036.536.917.425.114104036.53719.524.115104036.637.12022.616104036.736.918.322.717106036.63716.419.3Cefepime, Metronidazole, Vancomycin18106036.736.918.220.8Cefepime, Metronidazole, VancomycinTrach aspirate:<10 Epithelial cells, 10-25 PMN, 1+ Candida albicans19106036.73718.423.5Cefepime, Metronidazole, Vancomycin20107535.936.824.628.3Cefepime, Metronidazole, Vancomycin21108036.539.52528.5Cefepime, Metronidazole, Vancomycin Are criteria for VAC met?If so what dateIf criteria are met which definition is met (VAC, IVAC, PVAP)Case Study 2: Mr. Hubert TraumaJanuary 1st, a 72 year old male is seen in the ED, following a MVA. He sustained closed rib fractures, ruptured spleen, and dissection of the aorta. In the ED central lines and a Foley catheter were placed. He was admitted to the Trauma ICU on that same day where he was intubated and stabilized at a PEEP setting of 6 cm H2O and FiO? of 50%On mechanical ventilation (MV) Day 4 he required an increase in PEEP to 7.5 cm H2O and FiO? to 80%Utilize the information on table 1 to evaluate for VAE Table 1MV DayDaily Minimum PEEPDaily Minimum FI0?Event16.5026.5036.5047.5.8057.5.8067.5.7576.7586.7596.60108.80118.80126.60136.60146.60Question(s)Are criteria for VAC met?If so what DateIf criteria are met when does the VAE window begin and end?Mr. Hubert Trauma becomes febrile and is started on antibiotics.Utilize the information on Table 2 to evaluate status.Table 2MV DayDaily Minimum PEEPDaily Minimum FI0?Temp MinTemp MaxWBC MinWBC MaxABXSpecimenPolys/EpisOrganism(s)16.50N26.50N36.50N47.5.8036.537.37.29.2N57.5.8036.338.97.48.4NBAL>25/<1010? Kleb. p67.5.7537.338.58.58.8Pip/Taz76.75Pip/Taz86.75Pip/TazBloodKleb. pneu96.60Pip/Taz108.80Pip/Taz118.80Vanc126.60136.60Vanc146.10037.039.58.815.0VancPatient expiredQuestionBased on the data above what do you think?IVAC MV Day 4 with a secondary BSIPossible VAP Day 4 with a secondary BSIVAC MV Day 14VAC Day 14 and possible VAP Day 4What event be reported to NHSN for Mr. Hubert Trauma? ................
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