Prevention of ventilator-associated pneumonia

Abstract

Invasive mechanical ventilation (IMV) represents a risk factor for the development of ventilator-associated pneumonia (VAP), which develops at least 48h after admission in patients ventilated through tracheostomy or endotracheal intubation. VAP is the most frequent intensive-care-unit (ICU)-acquired infection among patients receiving IMV. It contributes to an increase in hospital mortality, duration of MV and ICU and length of hospital stay. Therefore, it worsens the condition of the critical patient and increases the total cost of hospitalization. The introduction of preventive measures has become imperative, to ensure control and to reduce the incidence of VAP. Preventive measures focus on modifiable risk factors, mediated by non-pharmacological and pharmacological evidence based strategies recommended by guidelines. These measures are intended to reduce the risk associated with endotracheal intubation and to prevent microaspiration of pathogens to the lower airways.

Lung hyperinflation by mechanical ventilation versus isolated tracheal aspiration in the bronchial hygiene of patients undergoing mechanical ventilation

“…Patients are subject not only to the benefits of this support but also to various risk factors, such as the development of mechanical ventilation-associated pneumonia (VAP). ( 2 ) VAP is one of the main factors contributing to increases in mortality, length of stay in the intensive care unit (ICU), overall hospitalization time and health-related costs. ( 2 , 3 )…”

“…( 2 ) VAP is one of the main factors contributing to increases in mortality, length of stay in the intensive care unit (ICU), overall hospitalization time and health-related costs. ( 2 , 3 )…”

“…Tracheal intubation, immobility imposed on the patient for sedation and general weakness with diminished cough effectiveness reduce mucociliary transport and promote the retention of secretions in the airway. ( 2 , 4 ) Lung secretion buildup can cause increased airway resistance and partial or total airway obstruction, with consequent alveolar hypoventilation and the development of atelectasis and hypoxemia and increased effort needed to breathe. ( 5 , 6 ) The care of these patients includes tracheal aspiration, which is used to facilitate the removal of secretions from the airway.…”

Boas práticas de enfermagem a pacientes em ventilação mecânica invasiva na emergência hospitalara

“…33 Tracheal intubation and immobility imposed on the patient by sedation reduce mucociliary transport and promote retention of airway secretions. 34 Also, the endotracheal tube facilitates bacterial colonization of the tracheobronchial tree and predisposes to aspiration of secretion contaminated by decreased cough reflex, accumulation of secretion above the ballonet (subglottic space) and by the contamination of the tube itself. 22 Therefore, an important nursing care for mechanically ventilated patients is the aspiration of endotracheal secretion, necessary to maintain a permeable airway and facilitate ventilation and consequent gas exchange.…”

Endotrakealtube med subglottis-sug kan forebygge ventilatorassosiert pneumoni

“…Mikroorganismer når nedre luftveier hovedsakelig ved mikroaspirasjon av sekresjon fra svelget eller sekresjon aspirert til svelget fra magesekken (gastrisk refluks). Mikroorganismer når nedre luftveier også ved direkte forlengelse av en pågående infeksjon, inhalasjon av kontaminerte aerosoler, eller av hematogen spredning av mikroorganismer fra andre infeksjonsfokus (9).…”