Ventilator-associated pneumonia (VAP) is a type of lung infection that occurs in people who are on breathing machines in hospitals. It affects critically ill persons that are in an intensive care unit (ICU). VAP is a major source of increased illness and death. Persons with VAP have increased lengths of ICU hospitalization and have up to a 20-30% death rate.Prevention of VAP involves limiting exposure to resistant bacteria, discontinuing mechanical ventilation as soon as possible, and a variety of strategies to limit infection while intubated. How can prevent Ventilator-associated pneumonia in ICU wards?
Dear Nader! With my pleasure. Please read carefully all papers in the attachment. Vladimir
Although they seem very basic, I would recommend you begin with the simplest that will surely be helpful to your patients on mechanical ventilation:
- Hand hygiene (before and after patient contact)
- Always keep the patient in semirecumbent position always (> 30 °)
- Keep cuff pressure endotracheal tube between 20-30cmH2O
- Use of closed suction systems and passive humidifiers (HMEF) (decrease the need to open the ventilatory circuit)
- Systematically remove oropharyngeal secretions
- Apply weaning and sedation-analgesia protocols
It is always good to start at the beginning..
Best wishes. Gustavo Plotnikow (RT, Buenos Aires, Argentina)
Dear Jo,
Chlorhexidine mouthwashes a good method. But VAP depends on some other factors too. Please explain them.
See Vladimir's comment above and the texts that he posted.
In addition to this, I am inclined to think that equally distributed lung ventilation prevents from VAP. So, try to assure equal lung ventilation.
I personally think that many of our patients may remain on assisted ventilation. Also, if you can, change the patient position frequently. How often is hard to say: as often as you can. Some lung region will collapse even after 10 minutes. A bed that permanently changes its position may be a solution for this part of the problem. It is hard to implement though.
SALAM Nader,
More guidelines on the topic (attached) that might be of help.
regards
Bassem
Prophylaxis for peptic ulcer disease and deep venous thrombosis do not directly impact VAP reduction. Other methods to reduce VAP, such as oral care and hygiene, chlorhexidine in the posterior pharynx, and specialized endotracheal tubes (continuous aspiration of subglottic secretions, silver-coated), should be considered for inclusion in a revised Ventilator Bundle more specifically aimed at VAP prevention.
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