Protecting your Patients from Ventilator-Associated Pneumonia

Protecting your Patients from Ventilator-Associated Pneumonia

Ventilators save patients’ lives. Mechanical ventilation, in fact, helps critical care patients breathe when they cannot do so on their own. But unfortunately, they can be associated with complications including ventilator associated pneumonia, or VAP, an airway infection that typically develops 48 hours or later after your patient is intubated, indicating the infection wasn’t there to begin with.[1]

While great strides have been made in preventing VAP, it’s still a real threat for your patients on ventilators. VAP is one of the most common and most deadly infections in ICU patients.[1] Those who develop VAP have a mortality rate of 45 percent in comparison to 28 percent for patients on ventilators who do not develop the infection.[1]

Why do patients develop VAP?

VAP occurs when bacteria invade the pulmonary system through the endotracheal tube. The tube provides a direct entry for airborne pathogens to set up shop and pool in the lungs. The endotracheal tube also prevents patients from coughing to clear such pathogens as they would normally do when not on a ventilator. [1]

The elderly and immune compromised develop VAP at an increased rate as do patients with existing pulmonary disease such as COPD or emphysema. Other risks include prolonged ventilator usage, an extended supine position of the patient and lax infection protocols such as handwashing in ICU. [1]

Get the pressure right:

Cuff pressure is as important as cuff materials in maintaining the health and comfort of ventilated patients. Under inflation can cause the patient to aspirate (3) fluids, and over inflation can cause tracheal ischemia (1), inadequate blood supply to an area due to a blockage of blood vessels by the tube itself. Thus, respiratory therapists should work to maintain proper cuff pressure (3) at all times through whatever monitoring methods work best.

Prevention of VAP

Intervention may decrease the average duration of mechanical ventilation, length of stay, mortality and costs. The following are recommendations in prevention of VAP with high and moderate resulting outcomes:

  • Use noninvasive positive pressure ventilation
  • Manage patients without sedation whenever possible
  • Interrupt sedation daily
  • Assess readiness to extubate daily
  • Perform spontaneous breathing trials with sedatives turned off
  • Facilitate early mobility
  • Utilize endotracheal tubes with subglottic secretion drainage ports for patients expected to require greater than 48 or 72 hours of ventilation [3]

Additional nursing interventions that can help prevent VAP include:

  1. Excellent hand-washing practices before touching the patient or ventilator [1]
  2. Regular oral hygiene care with an antiseptic solution [1]
  3. Elevate the head of the bed to a 30 to 45 degree angle. Research has found a reduced VAP rate for patients who were in a semi-recumbent position [1] [3]

Nursing and respiratory therapists have a significant role in the prevention of their patient’s VAP. A grouping approach of these best practices and latest recommendations can help you more effectively manage your patients’ risk of developing VAP.

References

[1] The Sentinel Watch. How to Prevent Ventilator Associated Pneumonia. [Cited May 27, 2013]. https://www.americansentinel.edu/blog/2013/05/27/preventing-ventilator-associated-pneumonia-vap/
[2] Drakulovic MB. Supine Body Position as a Risk Factor for Nosocomial Pneumonia in Mechanically Ventilated Patients: a Randomized Trial. The Lancet. [Cited Nov 27, 1999]. https://www.ncbi.nlm.nih.gov/pubmed/17558495
[3] Klompa M. JStor. Strategies to Prevent Ventilator Associated Pneumonia in Acute Care Hospitals: 2014 Update. [Cited Aug. 2014]. http://www.jstor.org/stable/10.1086/677144