Ventilator Associated Pneumonia in Adult Patients Preventive Measures: A Review of the Recent Advances

Abstract

Ventilator Associated Pneumonia (VAP) is the most commonly acquired ICU infection worldwide affecting nearly 10-30% of ventilated patients and accounting for nearly 25% of all types of ICU infections. VAP has been associated with increased morbidity, mortality, duration of ICU stay, duration of mechanical ventilation and nearly 50% of the ICU antibiotic prescription. After understanding the pathogenesis of VAP, various preventive measures have been tried by various authors. The currently accepted preventive measures are being used in most centres as the VAP prevention bundle. This includes: elevation of the head of the bed between 30°and 45°, daily sedation interruption and assessment of readiness to extubate, daily oral care with Chlorhexidine, peptic ulcer disease prophylaxis and deep vein thrombosis prophylaxis. In the current manuscript, we will be discussing the available preventive measures. Other measures which have been shown to be effective include selective oropharyngeal and digestive tract decontamination, use of antimicrobial coated ET tubes. However, more studies need to be done to see if these can be included in the VAP prevention bundle.

Experience of Nurses in the Prevention of Ventilator-Associated Pneumonia Among Critically Ill Patients at Muhimbili National Hospital in Dar es Salaam

“…Similar results from a study conducted in India revealed that assessment of redness to extubate, trial extubation, maintenance of ETT cuff pressure, and suctioning were the roles in preventing VAP (17).…”

“…Furthermore, the study has revealed early weaning, head of bed elevation of 30-45º, oral care, administration of medication (antibiotics/prophylaxis), and implementation of IPC measures as the common nursing interventions for VAP prevention. This shows that nurses were implementing the VAP bundle components in their setting, In support of the above ndings, previous work from the India, USA, and Spain revealed that early weaning, head of bed elevation of 30-45º, oral care, administration of medication (antibiotics/prophylaxis), and implementation of IPC measures were important nursing interventions in the prevention of VAP (17,18,19). However, contrary to our ndings, studies from the USA, and Australia showed additional strategies such as avoiding intubation, preventing re-intubation, use of sedation protocols, early initiation of enteral feeding, oral care with toothbrush and chlorhexidine, non-invasive positive pressure ventilation prone position, and changing ventilator circuits when soiled were the common strategies used to prevent VAP (8, 20).…”

Suction circuit flushing with chlorhexidine decreases ventilator-associated pneumonia: a quasi-experimental study

“…A prospective observational study, involving patients from 27 ICUs in nine European countries, reported that VAP resulted in 6% higher mortality, longer ICU length-of-stay (10 and 12 days), and increased duration of mechanical ventilation ( 35 ). Furthermore, systematic reviews with meta-analysis of randomized controlled trials revealed that VAP occurrence increased the ICU length-of-stay and duration of mechanical ventilation ( 36 , 37 ). This might explain the reason why most of our study population with a confirmed VAP had an ICU length-of-stay of more than 7 days.…”

Experience of nurses in the prevention of Ventilator-Associated Pneumonia among critically ill patients at Muhimbili National Hospital in Dar Es Salaam

“…Similar results from a study conducted in India revealed that assessment of redness to extubate, trial extubation, maintenance of ETT cuff pressure, and suctioning were the roles in preventing VAP. (19) Furthermore, the study has revealed early weaning, head of bed elevation of 30-45º, oral care, administration of medication (antibiotics/prophylaxis), and implementation of IPC measures as the common nursing interventions for VAP prevention. This shows that nurses were implementing the VAP bundle components in their setting, In support of the Original article PAJEC above findings, previous work from India, USA, and Spain revealed that early weaning, head of bed elevation of 30-45º, oral care, administration of medication (antibiotics/prophylaxis), and implementation of IPC measures were important nursing interventions in the prevention of VAP.…”