Since mechanically ventilated patients cannot be fed orally, their salivary secretions decrease, and self-cleansing of the oral cavity is markedly reduced. As a result, oral cavity hygiene worsens, and the number of bacteria increases excessively, leading to bacterial colonization of the oropharynx.
Methods : Patients more than 18 years old receiving mechanical ventilation for more than 48 hours in a medical intensive care unit at a university-affiliated medical center were studied in 2 consecutive 24-month periods. Patients in the group studied before the intervention (n = 779) had no oral assessments, no suctioning of the subglottic space, no tooth brushing, and suctioning of secretions in the oral cavity as needed. The group studied during the intervention (n = 759) included patients treated under a protocol whereby the oral cavity was assessed, deep suctioning was done every 6 hours, oral tissue cleansing was done every 4 hours or as needed, and tooth brushing was done twice daily. Results: Compliance with protocol components exceeded 80%. The rate of ventilator-associated pneumonia was 12.0 per 1000 ventilator days before the intervention and decreased to 8.0 per 1000 ventilator days during the intervention ( P = .06). Duration of mechanical ventilation and length of stay in the intensive care unit differed significantly between groups, as did mortality.
Prospective, randomized, single-blind, controlled study conducted in 54 centers in North America. A total of 9417 adult patients (18 years) were screened between 2002 and 2006. A total of 2003 patients expected to require mechanical ventilation for 24 hours or longer were randomized. Patients were assigned to undergo intubation with 1 of 2 high volume, low-pressure endotracheal tubes, similar except for a silver coating on the experimental tube.
“ A STITCH IN TIME SAVES NINE” ALI SHAMSEDDINE, BS, RT AUBMC
Studies using radiolabeled enteral feeding solutions have reported that aspiration of gastric contents occurs to a greater degree when patients are in the supine position, compared with the semi-recumbent position.
The semirecumbent body position is a low-cost and easy-to-apply measure to reduce the risk of nosocomial pneumonia.
The guidelines suggest keeping patients in the semirecumbent (30°-45°) to prevent aspiration.
The available evidence suggests that semi-recumbent position should be used routinely.
7. Type of airway humidification (Active Vs. Passive)
Evidence is lacking related to (VAP) and issues of heated versus unheated circuits, type of heated humidifier, method for filling the humidifier, and technique for clearing condensate from the ventilator circuit.
Respir Care 2003;48(9):869–879/ Evidence-Based Guidelines
A significant reduction in the incidence of VAP in patients
humidified with HMEs was found, particularly in patients ventilated for 7 days or longer. Intensive Care Med (2005) 31:5–11
Issues related to the use of passive humidifiers (resistance, dead space volume, airway occlusion risk) preclude a recommendation for it’s general use.
Silver-coated ETT prevents bacterial colonization and biofilm formation.
Patients receiving a silver-coated endotracheal tube had a statistically significant reduction in the incidence of VAP and delayed time to VAP occurrence compared with those receiving a similar, uncoated tube.
No significant change in durations of intubation, ICU stay, and hospital stay; mortality; and frequency and severity of adverse events.
Since the avoidance of intubation certainly has a dramatic impact on the risk of VAP, it appears that the indications for and standards of noninvasive ventilation should be established with high priority