All right, so welcome back to the Internet Book of Critical Care podcast.

I'm here with Adam Thomas and we're going to talk about ventilator associated ammonia or

VAP.

How much frustration has this given you, Josh?

Like how much minutes of the day do you think when you're in the unit? Do you have to commit to this?

This is infinitely frustrating.

Today we'll cover a stepwise approach, as you've already posted, multiple steps, and

let's just say it all comes down to maybe, maybe not.

But Josh has at least tried to form together.

But Josh, let's start it off with the riddle of VAP,

as you call it. This is not a straightforward answer. And there's some problems with either

overtreating, under-treating, under-investigating, or just flipping a coin. So map this nuance out

for me. I think the real root of the problem here is that we do not have a gold standard test

to determine whether or not

a patient has ventilator associated pneumonia. So if you wanted to say with 100% certainty that a

patient has ventilator associated pneumonia, you would probably need to do like a surgical

lung biopsy or an autopsy on them. There's no other test that's 100% sensitive and specific.

And this leads to these enormous problems of circular logic.

So depending on how you define VAP, you can end up defining lots of people with VAP.

You can end up defining fewer people with VAP. And I'm just always questioning if we're

overtreating or under treating patients. I just, I can't get to the bottom of this. Do you have

some solution to this? Just give them all Peptazzo, Josh. It's pretty easy. If they live, you're good.

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