Prevention of VAP: role of the artificial airway, body position and setting the ventilator

Ventilator-associated pneumonia prevention: one good turn does not always deserve another

“…The lower incidence of VAP with LTP (eight times lower) reinforces the concept that macroand microaspiration of oropharyngeal secretions have a key role in the pathogenesis of VAP [4].…”

“…Its presence compromises the natural anatomical barriers (larynx) and functional mechanisms (mucus clearance and cough), and it expedites the formation of biofilm as well as macro-and microaspiration of oropharyngeal secretions. As a result, several strategies have been successfully implemented, namely subglottic secretion drainage or cuff pressure control [3,4].One of the current recommendations for VAP prevention is elevation of the head of bed to 30-45° to prevent the reflux of colonized gastric contents that has a potential role in VAP pathogenesis. This strategy has been evaluated in three randomized controlled trials (RCT) enrolling 337 patients, one positive and two negatives [5][6][7], and in a meta-analysis pooling these three studies that found a significant impact on prevention [8].…”

“…The key factor in the pathogenesis of VAP is the endotracheal tube (ETT) [4]. Its presence compromises the natural anatomical barriers (larynx) and functional mechanisms (mucus clearance and cough), and it expedites the formation of biofilm as well as macro-and microaspiration of oropharyngeal secretions.…”

“…Its presence compromises the natural anatomical barriers (larynx) and functional mechanisms (mucus clearance and cough), and it expedites the formation of biofilm as well as macro-and microaspiration of oropharyngeal secretions. As a result, several strategies have been successfully implemented, namely subglottic secretion drainage or cuff pressure control [3,4].…”