Current strategies for preventing ventilator-associated pneumonia (VAP)

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Abstract

Introduction: The hospital environment is contaminated by several potentially resistant microbiological agents, which colonize the patient himself. Ventilator-associated pneumonia (VAP) is a healthcare-related infection (HAI) acquired after 48 hours of mechanical ventilation (MV), which affects the lower respiratory tract, associated with clinical, radiological and laboratory changes, negatively impacting the clinical picture. Objective: To discuss the non-pharmacological strategies recommended in the current literature for the prevention of VAP in critically ill adult patients admitted to the ICU. Discussion and Results: Advanced life support increases the survival of critically ill patients, however, the need for the use of invasive devices and the hospital environment predispose these individuals to infections, such as VAP, requiring the implementation of systematized routines, known worldwide as Bundles. The non-pharmacological strategies that currently contemplate VAP prevention bundles are: daily interruption of sedation; spontaneous breathing test (ERT), bed positioning; cuff pressure; oral care; saline instillation; closed suction system; subglottic secretion aspiration system. The use of these strategies in hospital care is low cost, easily executable and low risk of harm to the patient, capable of potentially reducing VAP notifications. Conclusion: The high incidence of VAP negatively impacts on increased mortality, ICU and hospital admission, care costs and worsening of the patient's clinical outcome, requiring early diagnosis and intervention, as well as the implementation of protocols and training that integrate the multidisciplinary team to prevent this hospital infection.

Keywords: Ventilator-associated pneumonia; prevention; Guidelines; critical patient.