Ventilator-Associated Pneumonia FREE

Ventilator-associated pneumonia (VAP) is a common and serious complication in critically ill patients who require a ventilator to breathe for them. This condition results in prolonged hospital stays and increased treatment costs. Ventilator-associated pneumonia is believed to result from aspiration (inhalation) of throat or stomach secretions contaminated with certain organisms.

To help reduce the occurrence of VAP by providing physicians with information on which preventive methods are most effective.

The authors reviewed numerous clinical studies that followed critically ill patients through treatments designed to reduce their risk for VAP. The methods reviewed were 1) raising the heads of patients' beds to a 45-degree angle, 2) changing the drug used for prevention of stress ulcers, 3) continuously suctioning secretions in the throat, 4) regularly changing patients' position using automatic beds, 5) prescribing preventive antibiotics that target organisms associated with VAP, 6) changing ventilators' circuitry less frequently, and 7) tube feeding directly into the intestines to avoid gastroesophageal reflux (the return of stomach contents through the esophagus).

Raising the heads of patients' beds to a 45-degree angle reduced the occurrence of VAP. Medications called H₂-antagonists, which are frequently used to prevent stress ulcers in critically ill patients, alter the stomach's pH level and may allow the growth of organisms that cause VAP. Sucralfate, another preventive drug that does not affect the stomach's pH level, reduced the occurrence of VAP but offered less protection against gastrointestinal bleeding. Mixed results were reported with continuous suctioning of throat secretions. This method may be appropriate in patients requiring ventilator assistance for more than 3 days. Automatic beds reduced the occurrence of VAP only in surgical and neurologic patients. Although targeted antibiotic treatment reduced occurrence, there are concerns about development of antibiotic resistance if these drugs are widely prescribed. Less frequent changes of ventilators' circuitry or of heat and moisture exchanger filters did not increase VAP incidence. No difference in VAP occurrence was found with intestinal tube feeding.

Doctors caring for patients on ventilators should consider 1) raising the heads of patients' beds to a 45-degree angle, 2) using sucralfate instead of H₂-antagonists to prevent stress ulcers in patients at low to moderate risk for gastrointestinal bleeding, 3) continuously suctioning throat secretions in patients on ventilators for more than 3 days, and 4) using automatically repositioning beds (in surgical and neurologic patients only). The authors noted that no studies have evaluated combinations of these preventive measures and recommended future research in this area.