Mechanical ventilation is a core component of supportive therapy for critical care patients who cannot breathe adequately on their own. It is the most fatal of the hospital acquired infections, with higher mortality rates than either central line infections or sepsis. Ventilated patients who develop VAP have mortality rates of 45 percentcompared to 28 percent for ventilated patients who do not develop VAP.
VAP has garnered so much attention because of its effects on morbidity, mortality and costs. Even when aggressively treated, for example, the condition adds an average of four to nine days to ICU stays.
There are significant differences in how VAP is prevented in North America and Europe, for example, that reflect not only differences in medical practice, but different interpretations of the medical literature.
Some strategies like good hand hygiene are considered to be effective but widely underused.
When appropriate, using noninvasive mask ventilation is still one of the best ways to prevent VAP, particularly when treating patients with COPD. These approaches, however, are just the tip of the iceberg when it comes to preventing VAP. The short list of interventions in this article examines practices that address three key areas in VAP prevention: We start by examining strategies that are best supported by evidence and move on to strategies that may be effective, but are either controversial or poorly supported by the literature.
In part, that may be because of debate about just how much elevation is needed.
With the exception of certain fracture and post-neurosurgery patients and those with severe hypotension, however, experts say that elevating the head of the bed for these patients is safe and effective. Some of our teams are consistently successful 90 percent of the time now.
Sedation vacation and weaning assessment. It is wellestablished that the sooner patients are extubated, the lower their risk of developing VAP. Boiteau notes, that assessment occurs twice a day.
Instead of relying on physicians to remember the assessment, the trick is to make sure that the assessment is part of a process. Continuous subglottic secretion removal. Several trials support the benefits of using tubes that continuously drain these secretions.
That includes relatively new tubes that are fitted with separate dorsal lumens above the cuff and allow for easier suctioning.
Experts acknowledge, however, that this strategy presents several challenges. Correct placement and management, for example, requires a skilled provider team, because pressure of the tube cuff must be adequate to prevent secretion leakage into the lower airway. In addition, some early-generation tubes have been associated with malfunction problems.
If you can prevent one case of VAP and save 4. These tubes are recommended primarily for patients who are likely to remain on ventilators for three days or longer, and they need to be inserted early on. Saint says that these barriers may make it challenging to convince your hospital to embrace them, but they still hold much potential.
A growing body of evidence suggests that oral tubes may be better than nasal tubes in preventing VAP, Dr. Boiteau notes, but the evidence is largely inferential. The theory, which has been supported by published studies, says that oral tubes reduce sinusitis, a condition that is associated with the development of VAP in a number of patients.
Nasal tubes prevent normal drainage of the sinuses. Extrapolations from other studies have shown higher rates of VAP in patients with nasal tubes. Targeted oral hygiene with use of oral chlorhexidine gluconate washes. These strategies, for example, have proven effective in reducing pneumonia in nursing home patients.
And while chlorhexidine washes are a relatively new area of study, the fact that these agents have reduced VAP in cardiac-surgery patients may have ramifications for ICU patients in general, even if there is not yet any direct evidence that it produces the same results in typical ICU patients.Ventilator-associated pneumonia is a lung infection that develops in a person who is on a ventilator.
A ventilator is a machine that is used to help a patient breathe by giving oxygen through a tube placed in a patient’s mouth or nose, or through a hole in the front of the neck.
The intent of this document is to highlight practical recommendations in a concise format to assist acute care hospitals in implementing and prioritizing strategies to prevent ventilator-associated pneumonia (VAP) and other ventilator-associated events (VAEs) and to improve outcomes for mechanically ventilated adults, children, and neonates.
The following strategies to prevent ventilator-associated pneumonia in acute care hospitals were published in a supplement from Infection Control and Hospital Epidemiology, October , Vol.
29, Supplement 1 SS In this webinar, John Gallagher will explain the use of the terms ventilator associated events (VAE) and ventilator associated pneumonia (VAP). He will then review strategies to prevent intubation and nursing interventions to reduce the risk of complications and promote early liberation from the ventilator.
Ventilator-associated pneumonia (VAP) is defined as pneumonia in a patient intubated and ventilated at the time of or within 48 hours before the onset of the event.
(There is no minimum period of time that the ventilator must be in place in order for the pneumonia to be considered ventilator-associated.).
Jan 01, · Assessment of the effectiveness of a ventilator associated pneumonia prevention bundle that contains endotracheal tube with subglottic drainage and cuff pressure monitorization. The Brazilian Journal of Infectious Diseases, Vol. 21, Issue.