Abstract
Prevention of nosocomial pneumonia (NP) is the most important step towards reducing hospitalisation costs. The non-antibiotic prevention strategies include measures related to the correct care of the artificial airway, strategies related directly to the maintenance of the mechanical ventilator and the equipment, strategies focused in the gastrointestinal tract, and strategies related to the position of the intubated patients. While simple methods should be part of routine practice, the use of more invasive and expensive preventive measures should be used only in patients who are at high risk of NP. The appropriate use of these techniques can reduce the incidence of NP in intensive care unit patients.
Highlights
Ventilator-associated pneumonia (VAP) is the specific type of nosocomial pneumonia (NP) that occurs after the first 48 hours of initiating mechanical ventilation, and can be further differentiated into early VAP (< 5 days after tracheal intubation) and lateonset VAP (> 5 days after tracheal intubation) [1]
A variety of measures has been suggested for prevention of NP depending on the setting and the individual risk profile, non-antibiotic strategies being the main topic of this review (Table 1)
Non-antibiotic preventive strategies for nosocomial pneumonia in mechanically ventilated patients according to their effectiveness based on criteria of the Centers for Disease Control (CDC) [30] and of the European Task Force on ventilatorassociated pneumonia (Task Force) [65]
Summary
Stagnant oropharyngeal secretions pooled above the cuff can gain access to lower airways when the pressure of the cuff decreases spontaneously or there is a temporal deflation of the cuff, providing a direct route for tracheal colonisation and bolus aspiration from the oropharynx. In a case–control study in France, compared the use of non-invasive ventilation in chronic obstructive pulmonary disease exacerbation and in cardiogenic pulmonary oedema with the use of conventional mechanical ventilation in an historical control population They concluded that non-invasive mechanical ventilation is associated with a lower risk of nosocomial infections, with less antibiotic use, with a shorter length of ICU stay, and with lower mortality [61]. In immunosuppressed patients with pneumonitis and acute respiratory failure, early initiation of non-invasive ventilation has reduced the rate of endotracheal intubation and hospital mortality [64]. These studies suggest that prevention strategies should include efforts aimed at eliminating or at least reducing the frequency of tracheal intubation. Further investigation is needed in intubated patients regarding the impact of different ventilatory patterns, such as high or low tidal volumes, on the incidence of NP
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