What is new in the prevention of ventilator-associated pneumonia?

Abstract

Purpose of the reviewVentilator-associated pneumonia (VAP) remains a frequent and severe complication in endotracheal intubated patients. Strict adherence to preventive measures reduces the risk of VAP. The objective of this paper is to review what has come forward in recent years in the non-pharmacologically prevention of VAP. Recent findingsIt seems advantageous to implement care bundles rather than single prevention measures. A solid basis of knowledge seems necessary to facilitate implementation and maintain a high adherence level. Continuous educational efforts have a beneficial effect on attitude towards VAP. Intermittent subglottic secretions drainage, continuous lateral rotation therapy, and poly-urethane cuffed endotracheal tubes decrease the risk of pneumonia. In an in vitro setting, an endotracheal tube with a tapered shaped cuff appear to better prevent fluid leakage compared to cylindrical poly-urethane or polyvinylchloride cuffed tubes. Cuff pressure control by means of an automatic device and multimodality chest physiotherapy need further investigation, as does some aspects of oral hygiene. SummaryNew devices and strategies are developed to prevent VAP. Some of these are promising but need further study. Besides this, more attention goes to factors that might facilitate the implementation process and the challenge to achieve high adherence rates.

Ventilator-Associated Pneumonia in Neonatal Patients: An Update

“…However, VAP patients' mortality was no different from that of patients with infections in other locations [50]. Other studies have confirmed that VAP is associated with increased morbidity, a longer duration of MV, and a longer hospital and/or ICU length of stay [17,27,51,52]. Fischer et al [53] reported an incidence of VAP of 9.6% in a neonatal and pediatric population after cardiac surgery and found a delay in extubation of 3.7 days attributable to VAP.…”

“…Fischer et al [53] reported an incidence of VAP of 9.6% in a neonatal and pediatric population after cardiac surgery and found a delay in extubation of 3.7 days attributable to VAP. Similarly, Srinivasan et al [22], Elward et al [54], and Gautam et al [17] reported an increased length of stay and a longer duration of ventilation in pediatric and neonatal VAP patients with a tendency towards increased mortality that did not reach statistical significance [27,51,52]. …”

Head of Bed Elevation and Ventilator-Associated Pneumonia

“…[1][2][3][4] These initiatives have also stimulated efforts to prevent or minimize the frequency of VAP, and a variety of "ventilator bundles" have been developed. 7,8 Guidelines for hand hygiene, oral care, ventilator circuit tube changes, sedation, and spontaneous breathing trials are included in many such bundles. Elevation of the head of the bed (HOB) to minimize aspiration, particularly in patients receiving enteral nutrition, is also a common component of ICU ventilator bundles.…”

Impacto da aplicação de um programa educacional na prevenção da pneumonia associada à ventilação mecânica

“…Apesar de todas as evidências mostrarem a importância das mãos na cadeia de transmissão das infecções hospitalares e os efeitos dos procedimentos de higienização na diminuição das taxas de infecção, muitos profissionais têm uma atitude passiva diante do problema, enquanto os serviços adotam formas pouco originais e criativas para envolver os profissionais em campanhas educativas de higienização das mãos tendo uma aderência menor que 50% pelos profissionais da saúde (Blot et al, 2011).…”

“…A mudança no comportamento do profissional depende da percepção de que a PAV é um problema real e tem impacto sobre a mortalidade dos pacientes e que sua atitude na prática diária faz diferença na redução desta taxa, opinião esta similar a outros estudos (Blot et al, 2011).…”