Prevention of Ventilation Associated Pneumonia, New Ideas and Better Results

Abstract

The ventilation associated pneumonia is one the biggest challenge in the critical care team. It has a high mortality rate and an increase cost of the management. The use of the antibiotics did not show a great improvement in the survival rate. On the other hand, the prevention of ventilation associated pneumonia shows promising results, it improves the survival rate, decease both days of antibiotic use and days in the critical care unit. In the last 10 years, different methods used for the prevention of ventilator associated pneumonia. Some of those methods show a promising results while others need do not.We reviewed different methods of prevention including oral hygiene, probiotics, cuff pressure control, subglottic secretion drainage, endotracheal cuff, coated endotracheal tube, and the multisystem approach. We review the papers and the data supplement online, and we compared between the different methods in the short outcome, long outcome, length of stay in the ICU, and the cost of the management.

Oral Chlorhexidine Against Ventilator-Associated Pneumonia and Microbial Colonization in Intensive Care Patients

“…However, defense mechanisms in ICU patients are impaired by their illness and the multiple interventions that circumvent the natural host defenses. Insufficiency of protective mechanisms may lead to both local and systematic complications such as caries, periodontal disease, oral mucosal infections, bacteramia, infective endocarditis, sepsis, and ventilator-associated pneumonia (VAP; Darvishi Khezri et al, 2014; Matta, 2015; Par, Badovinac, & Plancak, 2014).…”

“…VAP, which is defined as parenchymal infection of the lung occurring in a patient who has been intubated and is being ventilated at the time or within 48 hr before the onset of pneumonia, is the most common nosocomial infection reported among such patients. The incidence of VAP ranges from 9% to 27% of all ICU infectious diseases (Haghighi, Baghari-Nesami, Baradari, & Charati, 2017; Hua et al, 2016; Matta, 2015; Zand et al, 2017; Zhang, Tang, & Fu, 2014). Critically ill patients who require mechanical ventilation (MV) are especially susceptible to VAP.…”

“…The development of VAP begins with the colonization of the dental plaque and oral mucosa by bacterial species such as Staphylococcus aureus, Pseudomonas aeruginosa , and Enterobacteriaceae (Andrews & Steen, 2013; Darvishi Khezri et al, 2014; Haghighi et al, 2017; Kandeel & Tantawy, 2012; Matta, 2015). Host-related factors like advanced age, certain medications, immobilization, supine body positioning, personnel-related factors, and device-related factors like the ventilator circuit and endotracheal tube are the main risk factors of VAP (Andrews & Steen, 2013; Atay & Karabacak, 2014; El-Rabbany, Zaghlol, Bhandari, & Azarpazhooh, 2015; Par et al, 2014; Tuon et al, 2017; Vidal et al, 2017).…”

“…Unfortunately, there is very limited literature on the best oral care approaches in ICU patients to direct choice of solutions, method and frequency of application. A few studies have reported that various preventive techniques contribute to reducing VAP rates (Atay & Karabacak, 2014; Hillier, Wilson, Chamberlain, & King, 2013; Matta, 2015).…”