Ventilator Associated Pneumonia

Ventilator-associated pneumonia (VAP) is defined as pneumonia that develop 48 hours post endotracheal intubation and initiation of mechanical ventilation

The following interventions following intubation and review thereof prevents VAP (Prevention care bundle)

• Elevation of the head of the bed 30° - 45°
• Decreases risk of aspiration and improves ventilation
• Daily “Sedation Vacation” (allow patient to wake once daily) paired with
• Daily assessment of readiness for extubation (Spontaneous breathing trail)
• Shortens time of ventilation with early weaning and extubation, thus less time on vent = less risk of VAP
• Peptic ulcer disease (PUD) prophylaxis
• Deep vein thrombosis (DVT) prophylaxis (unless contraindicated)
• Gastric decompression early naso / oro-gastric tube
• Maintenance of ETT Cuff pressure 20-30 cmH20
• Chlorhexidine oral rinses (12 hourly)
• Consider using antibacterial coated ETT (silver coated) or ETT with   supra-glottic suction port for continuous micro-aspiration of subglottic secretions (CASS)

References

• Grap MJ, Munro CL, Unoki T, Hamilton VA, Ward KR. Ventilator associated pneumonia: the potential critical role of Emergency Medicine in prevention. J Emerg Med 2012;42(3): 353-62.
• Wood S, Winters ME. Care of the intubated Emergency Department patient. J Emerg Med 2011;40(4): 419-427.
• Best Care Always Initiative - http://www.bestcare.org.za/