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What is new in the prevention of ventilator-associated pneumonia?

Stijn Blot (UGent) , Jordi Rello and Dirk Vogelaers (UGent)
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Abstract
Purpose of review: Ventilator-associated pneumonia (VAP) remains a frequent and severe complication in endotracheally intubated patients. Strict adherence to preventive measures reduces the risk of VAP. The objective of this paper is to review what has come forward in recent years in the nonpharmacological prevention of VAP. Recent findings: It seems advantageous to implement care bundles rather than single prevention measures. A solid basis of knowledge seems necessary to facilitate implementation and maintain a high adherence level. Continuous educational efforts have a beneficial effect on attitude toward VAP. Intermittent subglottic secretions drainage, continuous lateral rotation therapy, and polyurethane cuffed endotracheal tubes decrease the risk of pneumonia. In an in-vitro setting, an endotracheal tube with a taper-shaped cuff appears to better prevent fluid leakage compared to cylindrical polyurethane or polyvinylchloride cuffed tubes. Cuff pressure control by means of an automatic device and multimodality chest physiotherapy need further investigation, as do some aspects of oral hygiene. Summary: New devices and strategies have been developed to prevent VAP. Some of these are promising but need further study. In addition, more attention is being given to factors that might facilitate the implementation process and the challenge of achieving high adherence rates.
Keywords
ventilator-associated pneumonia, INTENSIVE-CARE UNITS, prevention, endotracheal tube, bundle, SUBGLOTTIC SECRETION DRAINAGE, EVIDENCE-BASED GUIDELINES, TUBE CUFF PRESSURE, NOSOCOMIAL INFECTION, ENDOTRACHEAL-TUBE, RANDOMIZED-TRIAL, KNOWLEDGE TEST, PROGRAM, NURSES

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Chicago
Blot, Stijn, Jordi Rello, and Dirk Vogelaers. 2011. “What Is New in the Prevention of Ventilator-associated Pneumonia?” Ed. Alimuddin Zumla. Current Opinion in Pulmonary Medicine 17 (3): 155–159.
APA
Blot, S., Rello, J., & Vogelaers, D. (2011). What is new in the prevention of ventilator-associated pneumonia? (A. Zumla, Ed.)CURRENT OPINION IN PULMONARY MEDICINE, 17(3), 155–159.
Vancouver
1.
Blot S, Rello J, Vogelaers D. What is new in the prevention of ventilator-associated pneumonia? Zumla A, editor. CURRENT OPINION IN PULMONARY MEDICINE. 2011;17(3):155–9.
MLA
Blot, Stijn, Jordi Rello, and Dirk Vogelaers. “What Is New in the Prevention of Ventilator-associated Pneumonia?” Ed. Alimuddin Zumla. CURRENT OPINION IN PULMONARY MEDICINE 17.3 (2011): 155–159. Print.
@article{1232996,
  abstract     = {Purpose of review: Ventilator-associated pneumonia (VAP) remains a frequent and severe complication in endotracheally intubated patients. Strict adherence to preventive measures reduces the risk of VAP. The objective of this paper is to review what has come forward in recent years in the nonpharmacological prevention of VAP.
Recent findings: It seems advantageous to implement care bundles rather than single prevention measures. A solid basis of knowledge seems necessary to facilitate implementation and maintain a high adherence level. Continuous educational efforts have a beneficial effect on attitude toward VAP. Intermittent subglottic secretions drainage, continuous lateral rotation therapy, and polyurethane cuffed endotracheal tubes decrease the risk of pneumonia. In an in-vitro setting, an endotracheal tube with a taper-shaped cuff appears to better prevent fluid leakage compared to cylindrical polyurethane or polyvinylchloride cuffed tubes. Cuff pressure control by means of an automatic device and multimodality chest physiotherapy need further investigation, as do some aspects of oral hygiene.
Summary: New devices and strategies have been developed to prevent VAP. Some of these are promising but need further study. In addition, more attention is being given to factors that might facilitate the implementation process and the challenge of achieving high adherence rates.},
  author       = {Blot, Stijn and Rello, Jordi and Vogelaers, Dirk},
  editor       = {Zumla, Alimuddin},
  issn         = {1070-5287},
  journal      = {CURRENT OPINION IN PULMONARY MEDICINE},
  keyword      = {ventilator-associated pneumonia,INTENSIVE-CARE UNITS,prevention,endotracheal tube,bundle,SUBGLOTTIC SECRETION DRAINAGE,EVIDENCE-BASED GUIDELINES,TUBE CUFF PRESSURE,NOSOCOMIAL INFECTION,ENDOTRACHEAL-TUBE,RANDOMIZED-TRIAL,KNOWLEDGE TEST,PROGRAM,NURSES},
  language     = {eng},
  number       = {3},
  pages        = {155--159},
  title        = {What is new in the prevention of ventilator-associated pneumonia?},
  url          = {http://dx.doi.org/10.1097/MCP.0b013e328344db65},
  volume       = {17},
  year         = {2011},
}

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