Nonantibiotic Measures to Control Ventilator-Associated Pneumonia

Abstract

Despite an increased understanding of the pathogenesis of hospital-acquired pneumonia (HAP) and advances in diagnosis and treatment, the risk, cost, morbility and mortality of HAP remain unacceptably high. Preventing HAP is the most important step to improve standard of care and cost-effectiveness. Prevention efforts must be part of an evidence-based, multidisciplinary prevention program with a team that sets prevention benchmarks, establishes goals and timelines, and provides education and training to the staff. Nonantibiotic prevention strategies include measures related to the correct care of the artificial airway, strategies related directly to maintaining the mechanical ventilator and equipment, and strategies focusing on the gastrointestinal tract and the position of intubated patients. In this chapter, a variety of measures are suggested for preventing HAP according to setting and individual risk profile, with nonantibiotic strategies being the main topic, in particular, semirecumbent position, continuous subglottic aspiration, chlorhexidine oral rinse, silver-coated endotracheal tubes, and probiotics.