Prevent ventilator assoc. pneumonia

Ventilator Associated Pneumonia (VAP) is one of the most common acquired infections ICUs. Rates of VAP range from 1 to 10 cases per 1,000 ventilator‐days. VAP mortality may exceed 10%. Patients with VAP require prolonged periods of mechanical ventilation, extended hospital/ICU stay, excess antibiotics, and increased medical costs. VAP occurs when there is bacterial invasion of the pulmonary parenchyma. Bacteria enter the lower respiratory tract from aspiration of secretions, colonization of the aerodigestive tract, or use of contaminated equipment or medications. Risk factors for VAP include prolonged intubation, enteral feeding, witnessed aspiration, paralytic agents, underlying illness, and extremes of age.

General Strategies to Prevent VAP

1. Use active surveillance to detect VAP
2. Hand Hygiene
3. Use non-invasive ventilatory methods when possible
4. Daily assessment of ability to wean ventilator

Prevent Aspiration

1. HOB 30-45 degrees
2. Prevent gastric overdistension
3. Prevent unplanned extubations/re-intubation
4. Cuffed ETT with in-line or subglottic suctioning
5. ETT cuff pressure of at least 20 cm H₂O

Avoid Colonization

1. Avoid nasotracheal intubation (increased risk of sinusitis)
2. Avoid H₂ blockers and PPIs unless the patient is at risk for stress ulcers
3. “Regular” oral care with anti-septic solution (regular is poorly defined)