There are substantial differences in prevention of Ventilator-associated pneumonia all over the globe with many of them emanating from differences in how medical literature is interpreted and also the medical practices employed. Strategies like maintenance of good hygiene have been reported to be very effective but the problem is that not many people use them. Thus, the discussion is dedicated on outlining strategies of VAP prevention.
Positioning the patient in semi-recumbent is crucial. Medical literature differs on the height of elevation with many quoting 30-45 degrees as the ideal height. However, there are others who do not agree with these figures. These differences have led to under-utilization of the strategy.
There is an exception to patients who have undergone neurosurgery and those having certain fractures. Experts emphasize the need for head elevation even if one is not sure just how high the elevation should be because at the end the patient stands to benefit even if the bed is just slightly raised.
Ventilator weaning assessment and sedatives withdrawals have been confirmed to be beneficial to ICU patients if done early enough. The sedatives should be withdrawn for at least six-eight hours daily and the patient assessed. If they can do without the drugs then they should be stopped. Extubation should be carried out as soon as the patient can maintain independent breathing. Breathing trials should be done once or twice in a day.
Continuously removing subglottic secretion is very helpful to patients at risk of VAP. Tubes are employed in achieving this. There are new tubes which have been fitted with isolated dorsal lumen to make the suctioning process easier. Early-generation tubes were reported to malfunction frequently even though they were cheap. The newer ones are coated with silver and are sold at slightly higher prices but the degree of their effectiveness is worth the extra cost.
Oral tubes are beneficial than nasal ones in Ventilator-associated pneumonia prevention. The nasally inserted tubes lead to sinus blockage which interferes with their drainage. If secretions remain there for long, they are likely to get infected and this is a major contributor to VAP. Nasal tubes should only be used in special cases when oral tubes are contraindicated.
Use of chlorhexidine gluconate in provision of oral hygiene is a very effective approach in ventilator-associated pneumonia prevention. Even though the evidence supporting the effectiveness of this strategy is not much, it has been confirmed to produce results. The measures are so inexpensive and benign and thus worth the trial.
Prevention of stress ulcers by provision of prophylaxis is emphasized in the at-risk population. This prevents occurrence of gastric bleeding which leads to VAP. The exact mechanisms which lead to this are not well understood but linkages have been demonstrated. Sucrasulfate is the only ulcer medication which is has been used in clinical trials. Proton-pump inhibitors, antacids and H2 blockers have been used in clinical trials but the studies are underpowered.
Positioning the patient in semi-recumbent is crucial. Medical literature differs on the height of elevation with many quoting 30-45 degrees as the ideal height. However, there are others who do not agree with these figures. These differences have led to under-utilization of the strategy.
There is an exception to patients who have undergone neurosurgery and those having certain fractures. Experts emphasize the need for head elevation even if one is not sure just how high the elevation should be because at the end the patient stands to benefit even if the bed is just slightly raised.
Ventilator weaning assessment and sedatives withdrawals have been confirmed to be beneficial to ICU patients if done early enough. The sedatives should be withdrawn for at least six-eight hours daily and the patient assessed. If they can do without the drugs then they should be stopped. Extubation should be carried out as soon as the patient can maintain independent breathing. Breathing trials should be done once or twice in a day.
Continuously removing subglottic secretion is very helpful to patients at risk of VAP. Tubes are employed in achieving this. There are new tubes which have been fitted with isolated dorsal lumen to make the suctioning process easier. Early-generation tubes were reported to malfunction frequently even though they were cheap. The newer ones are coated with silver and are sold at slightly higher prices but the degree of their effectiveness is worth the extra cost.
Oral tubes are beneficial than nasal ones in Ventilator-associated pneumonia prevention. The nasally inserted tubes lead to sinus blockage which interferes with their drainage. If secretions remain there for long, they are likely to get infected and this is a major contributor to VAP. Nasal tubes should only be used in special cases when oral tubes are contraindicated.
Use of chlorhexidine gluconate in provision of oral hygiene is a very effective approach in ventilator-associated pneumonia prevention. Even though the evidence supporting the effectiveness of this strategy is not much, it has been confirmed to produce results. The measures are so inexpensive and benign and thus worth the trial.
Prevention of stress ulcers by provision of prophylaxis is emphasized in the at-risk population. This prevents occurrence of gastric bleeding which leads to VAP. The exact mechanisms which lead to this are not well understood but linkages have been demonstrated. Sucrasulfate is the only ulcer medication which is has been used in clinical trials. Proton-pump inhibitors, antacids and H2 blockers have been used in clinical trials but the studies are underpowered.
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