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Nonpharmacologic Measures to Prevent Ventilator-Associated Pneumonia

Lorente, Leonardo MD, PhD

Clinical Pulmonary Medicine: March 2008 - Volume 15 - Issue 2 - pp 63-70
doi: 10.1097/CPM.0b013e31816728ac
Respiratory Infections

Ventilator-associated pneumonia (VAP) continues to be an important cause of morbidity and mortality in critically ill patients. Despite the numerous contributions in the field of the prevention of VAP in the last decade, the majority of issues related to the prevention of VAP remain unresolved and are subject to controversy. This review aims to summarize the nonpharmacologic measures for prevention of VAP and could help to design a VAP care bundle to prevent VAP as follows: oral rather than nasal intubation, maintenance of endotracheal tube cuff pressure between 20 and 30 cm of water, subglottic secretion drainage in patients expected to need mechanical ventilation longer than 72 hours, early extubation, avoidance of reintubation, use of noninvasive ventilation, early tracheostomy in patients expected to require prolonged mechanical ventilation, no routine change of ventilator circuits, heat and moisture exchanger when short-term mechanical ventilation is expected and heated humidifier when prolonged mechanical ventilation is expected, closed tracheal suctioning system rather than an open system, no routine change of closed tracheal suctioning system, sterilization of reusable respiratory devices, barrier infection-control measures, and semirecumbent position.

This review aims to summarize the evidence of the nonpharmacologic measures for prevention of ventilator-associated pneumonia (VAP) and could help in designing a VAP care bundle to prevent VAP.

From the Intensive Care Unit, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain.

Address correspondence to: Leonardo Lorente, MD, PhD, Intensive Care Unit, Hospital Universitario de Canarias, C/Ofra s/n, La Laguna, Tenerife 38320, Spain. E-mail: lorentemartin@msn.com.

© 2008 Lippincott Williams & Wilkins, Inc.