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 precautionsGood 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 positionVentilated patients should be nursed at 30 degrees or more to help prevent reflux of gastric contents and subsequent reflux.
Non-Invasive VentilationUsing NIV reduces the risks of a VAP so should be considered whenever possible.
Duration of Mechanical VentilationDaily 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 circuitCircuits do not need to be changed routinely and inline suctioning should be used to minimise the breaking of the circuit.
Oral HygieneThe use of chlorhexidine washes, teeth brushing and regular suctioning should all help reduce the bacterial load in the mouth.
GI TractAppropriate nutritional support should be maintained and peptic ulcer prophylaxis is recommended.
Positive End Expiratory PressureThe use of PEEP has been shown to reduce VAP

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6 Ways To Be Better With a BVM
Mechanical Ventilation- Physiologic Effects
Anatomy of Adult ETT
Mechanical Ventilation- Terminology
Mechanical Ventilation- Modes of Ventilation I
Mechanical Ventilation- Modes of Ventilation II
Mechanical Ventilation- Pressure/Volume/Flow Loops
Mechanical Ventilation- Peak Pressure and Plateau Pressure
PEEP (Positive End Expiratory Pressure)
Increase the rate or the tidal volume
Ventilation Screen- What do some of those numbers mean?
Phase Variables
I:E ratios and total cycle time.
Why do we ventilate?.
Volume controlled ventilation and compliance.
Lung compliance.
How do I describe how my patient is being ventilated?
Pressure/Volume loop
AC versus SIMV
A-a gradient
Pressure Support
Pressure Support Ventilation Curves
Pressure/Volume/Flow Curves
Ventilator Induced Lung Injury
Trigger, Limit and Cycle
Ventilator Associated Pnuemonia




Possibly the book I most highly recommend for nurses to use as their pocket guide. Phil Jevon is a practitioner in Walsall and has produced an easily read, pocket sized tool. You can click on the picture above  to purchase this excellent book.
Talley and O'Conner
Slightly less 'weighty' than Macleods but still with lots of useful detail and information. The latest copies also have a CD with good, well narrated examples of clinical examination.
This title is 'Highly Commended' in the 2006 British Medical Association Awards! 'an incredibly thorough book which is very well illustrated - a must in a book explaining how to perform examinations' - ("Medical Student Review"). This book will show you how to: talk with a patient; take the history from the patient; examine a patient; formulate your findings into differential diagnoses and rank these in order of probability; and, use investigations to support or refute your differential diagnosis.