Prevention of Ventilator associated Pneumonia

Recommendations

Recommendations to Prevent Ventilator associated pneumonia (VAP) and/or Ventilator associated events (VAEs) in Adult Patients

Avoid intubation and prevent reintubation. Use high-flow nasal oxygen or non-invasive positive pressure ventilation (NIPPV) as appropriate whenever safe and feasible (Strong Recommendation)

Minimize sedation

•       Avoid benzodiazepines in favour of other agents

•       Use a protocol to minimize sedation

•       Implement a ventilator liberation protocol (Strong Recommendation)

Maintain and improve physical conditioning (Strong Recommendation)

Elevate the head of the bed to 30-45° (Strong Recommendation)

Provide oral care with toothbrushing but without chlorhexidine (Strong Recommendation)

We recommend early enteral nutrition in preference to parenteral nutrition (Strong Recommendation)

Change the ventilator circuit only if visibly soiled or malfunctioning (or per manufacturers’ instructions) (Strong Recommendation)

Consider early tracheostomy (Conditional Recommendation)

Consider the use of endotracheal tubes with subglottic secretion drainage ports for patients expected to require >48–72 hours of mechanical ventilation (Conditional Recommendation)

Consider post pyloric rather than gastric feeding for patients with gastric intolerance or at high risk for aspiration (Conditional Recommendation)

Recommendations to Prevent VAP and/or VAE in Preterm Neonates

Use non-invasive positive pressure ventilation in selected populations (Strong Recommendation)

Minimize the duration of mechanical ventilation (Strong Recommendation)

Use caffeine therapy to facilitate extubation (Strong Recommendation)

Assess readiness to extubate daily (Strong Recommendation)

Manage patients without sedation whenever possible (Strong Recommendation)

Avoid unplanned extubations and re intubations (Strong Recommendation)    

Provide regular oral care with sterile water (Strong Recommendation)

Change the ventilator circuit only if visibly soiled or malfunctioning (or per manufacturer’s instructions) (Strong Recommendation)

Apply lateral recumbent positioning (Conditional Recommendation)

Apply reverse Trendelenburg positioning (Conditional Recommendation)

Consider closed/in-line suctioning systems (Conditional Recommendation)

Closed oral care with maternal colostrum (Conditional Recommendation)

Recommendations to Prevent VAP and/or PedVAE in Pediatric Patients

Avoid intubation if possible. Use non-invasive positive pressure ventilation for selected populations (Strong Recommendation)

Assess readiness to extubate daily in patients without contraindications (Strong Recommendation)

Take steps to minimize unplanned extubations and re intubations (Strong Recommendation)

Avoid fluid overload (Strong Recommendation)

Provide regular oral care (i.e., toothbrushing or gauze if no teeth) (Strong Recommendation)

Elevate the head of the bed unless medically contraindicated (Strong Recommendation)

Change ventilator circuits only if visibly soiled or malfunctioning (or per manufacturer’s instructions) (Strong Recommendation)

Prevent condensate from reaching the patient (Strong Recommendation)

Use cuffed endotracheal tubes (Strong Recommendation)

Maintain cuff pressure and volume at the minimal occlusive settings (Strong Recommendation)

Suction of oral secretions should be performed before each position change (Strong Recommendation)

Consider interruption of sedation daily (Conditional Recommendation)

Consider early tracheostomy (Conditional Recommendation)

Consider the use of endotracheal tubes with subglottic secretion drainage ports for older pediatric patients expected to require >48 or 72 hours of mechanical ventilation (Conditional Recommendation)