A patient in the ICU following a motor vehicle accident has been intubated for 72 hours. Over the previous 12 hours, the patient’s oxygen requirement has increased, tidal volumes have decreased, and the patient’s endotracheal secretions have increased in quantity, thickness, and the color has changed from cloudy to green. The patient’s lab values are significant for a worsening respiratory acidosis and leukocytosis. Which diagnosis is most appropriate for this patient?

Question

A patient in the ICU following a motor vehicle accident has been intubated for 72 hours. Over the previous 12 hours, the patient&rsquo;s oxygen requirement has increased, tidal volumes have decreased, and the patient&rsquo;s endotracheal secretions have increased in quantity, thickness, and the color has changed from cloudy to green. The patient&rsquo;s lab values are significant for a worsening respiratory acidosis and leukocytosis. Which diagnosis is most appropriate for this patient?

Accepted Answer

Ventilator-associated pneumonia. The patient is exhibiting signs of pneumonia, namely thick, green secretions, acidosis and increased respiratory requirements. Because the patient had been intubated for greater than 48 hours before onset of symptoms, it is ventilator-associated pneumonia. Symptom onset starting less than 48 hours after intubation can be designated community-acquired pneumonia. The patient&rsquo;s symptoms are not congruent with bronchiolitis (tachypnea, crackles, and/or wheezing) or reactive airway disease such as asthma (wheezing).

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