Non-Pharmacological Interventions to Prevent Ventilator-Associated Pneumonia: A Literature Review

Abstract

Ventilator-associated pneumonia (VAP) is a well-known complication of invasive mechanical ventilation in critically ill patients. The presence of an endotracheal tube (ETT) is one of the major culprits for VAP development: air flow moves pathogens toward the distal airways, while clearance of the trachea is blunted due to reduced tracheal ciliary movement and impaired cough. Several measures are recognized as being useful to prevent VAP, and these are usually grouped in a VAP bundle (ie, avoiding intubation or re-intubation whenever possible; head of bed elevation; hand hygiene; shortening ventilation through sedation interruptions, spontaneous breathing trials, or thromboembolic prophylaxis). However, other interventions have been proposed to reduce VAP rate; some of these interventions have been reported in large clinical trials to be effective, some have been evaluated in small observational studies, and still others at a pre-clinical stage. Some strategies aim to improve the ETT design via a subglottic drainage system, with treatment of the ETT surface to reduce pathogen activity, or by modification of the cuff shape or cuff material to provide a better seal. Another proposed strategy is improving airway care through control of cuff pressure, cleaning the ETT, or use of closed suction systems. Other interventions target a patient's position in the bed to reduce aspiration of digestive content in the airways, or the use of probiotics to modulate gastric flora. Some of these measures are supported by strong evidence, but the impact on relevant outcomes such as duration of ventilation or mortality, as well as cost-benefit ratio, is still unclear, resulting in lack of widespread use.

Development and Application of a New Type of Medical Protective Sputum Suction Respiratory Circuit

“…How to effectively prevent VAP has become one of most concerned issues in the eld of critical care medicine. At present, the important measure to prevent VAP by non-pharmacological methods in clinic is to prevent cross infection, and endotracheal sputum aspiration is the main way to cause cross infection in patients with mechanical ventilation 6 . Therefore, the use of appropriate sputum suction device can effectively reduce the occurrence of VAP.…”

“…The lower ori ce (1) of the adapter is connected with the tracheal intubation of the patient, and the side ori ce (10) is connected with the arti cial nose and the ventilator. An isolation sleeve (3) is inserted into the upper nozzle, and the bottom of the isolation sleeve is provided with cross-cross grooves (11) capable of penetrating sputum suction tubes, the grooves and grooves are respectively located on the edges (6), and the con uence of adjacent edges protrudes upward along the midline of the edges to form two pressure-bearing inclined planes (5) (Fig. 2A and 2B).…”

Effect of open versus closed endotracheal suctioning on intracranial pressure in severe brain‐injured children: Study protocol for a randomized controlled trial

“…Mechanical ventilation plays a key role in life support for children with severe head injury, and the airway management during mechanical ventilation is essential to the prognosis of patients (Fraga Gomes Martins et al., 2019 ). Intratracheal sputum suction is an important part in the management of children with mechanical ventilation, which acts to keep the children's airway open by removing the sputum or secretions in the airway (Coppadoro et al., 2019 ). If the suction cannot remove the sputum of patients in a timely and effective manner, it will not only affect the oxygenation function of children, but also colonize a large number of sputum and bacteria in the lungs and increase the risk of VAP (Dexter & Scott, 2019 ; Rouze et al., 2018 ).…”

Multi-criteria risk evaluation model for developing ventilator-associated pneumonia

“…Another fundamental measure in VAP prevention is patient positioning, with the suggested head-of-bed elevation between 30°and 45°, unless medically contraindicated (Álvarez Lerma et al 2014;Najafi Ghezeljeh et al 2018). Additional measures for preventing lung infections in intubated patients customarily include recommended airway management practices such as endotracheal aspiration using closed suction systems, respiratory physiotherapy, cuff shape, hand hygiene and appropriate endotracheal tube materials (Álvarez Lerma et al 2014;Kučan et al 2015), although in-depth research into the effectiveness of some of these measures is lacking (Coppadoro et al 2019).…”