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Yohanes WH George
Why Guidelines?
1. Evidence based practice
1.Best outcome for patients
2.Best use of resource
3.Constrain idiosyncratic behaviours
2. Legal protection
3. Identify research needs
4. A tool for education
5. Gain public confidence
HAP/VAP Guidelines
Name Year Method Scope Country Treatment Prevention Diagnosis
BSAC 2006 SR HAP UK
ATS 2005 SR HAP USA
Severe Sepsis
Included among the most frequent serious infections in
the ICU are:
Hospital-acquired pneumonia (HAP)
Severe sepsis.
19
Frequency of bacterial pathogens in HAP in
North America: 2,712 strains (SENTRY,
Antimicrobial Surveillance Program, Jan.-June
2000)
0 1 2 3 4 5 6 7
0 1 2 3 4 5 6 7
Timing Within five days of admission Five days or more after admission or
or mechanical ventilation mechanical ventilation
Clinical approach
Vs.
Invasive approach
Non-invasive Strategy for
Diagnosing HAP/VAP
Clinical approach:
New lung infiltrate
new onset fever, leukocytosis or purulent sputum
non-quantitative bacterial analysis of endotracheal
aspirate
Non-invasive Strategy for
Diagnosing HAP/VAP
Clinical approach:
Bila secara klinis curiga pneumonia dan hasil mikroskopi sekret saluran napas bawah positif, terapi
antimikrobial empirik dimulai dengan menggunakan algoritme Gb.2 dan data mikrobiologi lokal
Tabel 3. Terapi antibiotika empirik awal untuk
pasien dengan onset awal (early onset)
Bila secara klinis tidak curiga pneumonia dan hasil mikroskopi sekret saluran napas bawah negatif,
terapi antimikrobial empirik dimulai dengan menggunakan algoritme Gb.2 dan data mikrobiologi lokal
Hari ke 2 dan 3 : cek hasil kultur dan keadaan klinis (temperatur, leukosit, foto rontgen dada, oksigenasi,
sputum, perubahan hemodinamik dan fungsi organ)
Tidak Ya
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