Not-so-Trivial Pursuit: Mechanical Ventilation Risk Reduction

Abstract

As many as one-half of critically ill patients require mechanical ventilation. This paper will review a program of research focused on mechanical ventilation risk reduction. Airway management practices can have profound effects on outcomes in these patients. How patients are suctioned, types of processes used, effects of suctioning in lung injury, and open versus closed suctioning systems all have been examined to determine best practices.Pneumonia is a common complication of mechanical ventilation (ventilator-associated pneumonia, or VAP) and use of higher backrest elevation positions has been shown to reduce pneumonia risk, although compliance with recommendations is variable. The studies reviewed here describe backrest elevation practices, factors that affect backrest elevation, and the effect of backrest elevation on VAP.Oral care strategies also have been investigated to determine their effect on VAP. Oral care practices are reported to hold a low care priority, vary widely across care providers, and differ in intubated versus nonintubated patients. However, in several studies oral applications of chlorhexidine have been shown to reduce VAP.Although mechanically ventilated patients require sedation, the risks associated with sedation are significant. The overall goals of sedation are to provide physiologic stability, ventilator synchrony, and patient comfort—although methods to evaluate achievement of these goals are limited. Reducing risks associated with mechanical ventilation in critically ill patients is a complex and interdisciplinary process. Our understanding of the risks associated with mechanical ventilation is constantly changing, but it is paramount that care of these patients is based on the best evidence.