The most common cause of ventilator-associated pneumonia (VAP) is not the ventilator itself but rather the oral secretions from the patient which are then aspirated into the airways.
The organisms causing a VAP can arise from either the ventilator circuit or, as already said, from aspirations of secretions from above the endo tracheal tube.
Aspiration can occur due to the development of longitudinal folds in the endotracheal tube which allows leakage from above to below. Therefore one way to avoid a VAP is to minimise the secretions which might collect above the cuff.
|Hand hygiene and related precautions||Good hand hygiene and the wearing of gloves will help ensure that there is minimal transfer of bacteria from one patient to another for example.|
|Patient position||Ventilated patients should be nursed at 30 degrees or more to help prevent reflux of gastric contents and subsequent reflux.|
|Non-Invasive Ventilation||Using NIV reduces the risks of a VAP so should be considered whenever possible.|
|Duration of Mechanical Ventilation||Daily awakening trials and spontaneous breathing trails should be used to try to minimise the length of time the patient is on the ventilator.|
|Care of Ventilator circuit||Circuits do not need to be changed routinely and inline suctioning should be used to minimise the breaking of the circuit.|
|Oral Hygiene||The use of chlorhexidine washes, teeth brushing and regular suctioning should all help reduce the bacterial load in the mouth.|
|GI Tract||Appropriate nutritional support should be maintained and peptic ulcer prophylaxis is recommended.|
|Positive End Expiratory Pressure||The use of PEEP has been shown to reduce VAP|
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