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Preventing vent acquired pneumonia (VAP) in the icu - Essay Example

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Ventilator-associated pneumonia or VAP is one of the challenging complications in intensive care units and contributes to significant health care costs, morbidity and mortality. Hence, it is very important to prevent ventilator-associated pneumonia to optimize patient outcomes…
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Preventing vent acquired pneumonia (VAP) in the icu
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Prevention of VAP in ICU Ventilator-associated pneumonia or VAP is one of the challenging complications in intensive care units and contributes to significant health care costs, morbidity and mortality. Hence, it is very important to prevent ventilator-associated pneumonia to optimize patient outcomes. Several studies have been conducted in this regard and various measures have been outlined by researchers to prevent ventilator-associated pneumonia. According to Tablan et al (2004), it is very important to educate the medical professionals about strategies to decontaminate hands, microbiological surveillance and use of various barrier methods. Microbiological surveillance is important because it prevents emergence of multi-drug resistant bacteria and also in determining empirical therapy for patients with VAP. According to Babcock et al (2004), educating health professionals about prevention of VAP is critical for prevention of not only VAP, but also various nosocomial infections. Similar reports were delivered by Needleman et al (2002) and Cho et al (2003).
Another important strategy for prevention of VAP is early extubation and this is possible by following certain extubation protocols like interruption of sedation every day. According to Cook et al (2000), decreased time of mechanical ventilation decreases the risk of aspiration and consequently decreases VAP risk.
The third strategy useful to prevent VAP is prevention of aspiration. Nieuwenhoven et al (2006) have reported that evevation of bed at 45 degrees prevents aspiration. Timely drainage of secretions in the subglottic region which get contaminated easily (Bonten et al. 2004), avoiding manipulation of fluids in the ventilator circuits (Han and Liu, 2010) and use appropriate endotracheal cuff pressure (Valencia et al. 2007) also prevent aspiration of contaminated fluids and secretions.
There are several decontamination strategies which have been advocated for prevention of VAP. Some drugs like chlorhexidine are useful for oral decontamination. Selective decontamination of the intestines is possible by using antibiotics like polymyxin which are non-absorbable (Bonten and Krueger, 2006).
Thus, by adapting various pharmacologic and non-pharmacologic strategies, it is possible to prevent VAP in ICU patients.
References
Babcock, H.M., Zack, J.E., Garrison, T., Trovillion, E., Jones, M., Fraser, V.J. et al. (2004) An educational intervention to reduce ventilator-associated pneumonia in an integrated health system: a comparison of effects. Chest, 125, 2224–2231.
Bonten, M.J. and Krueger, W.A. (2006) Selective decontamination of the digestive tract: cumulating evidence, at last? Semin Respir Crit Care Med, 27, 18–22.
Bonten, M.J., Kollef, M.H. and Hall, J.B. (2004) Risk factors for ventilator-associated pneumonia: from epidemiology to patient management. Clin Infect Dis., 38, 1141–1149.
Cho, S.H., Ketefian, S., Barkauskas, V.H. and Smith, D.G. (2003) The effects of nurse staffing on adverse events, morbidity, mortality, and medical costs. Nurs Res., 52, 71–79.
Han, J. and Liu, Y. (2010) Effect of ventilator circuit changes on ventilator-associated pneumonia: a systematic review and meta-analysis. Respir Care, 55, 467–474.
Needleman, J., Buerhaus, P., Mattke, S., Stewart, M. and Zelevinsky, K. (2002) Nurse-staffing levels and the quality of care in hospitals. N Engl J Med., 346, 1715–1722.
Tablan, O.C., Anderson, L.J., Besser, R., Bridges, C. and Hajjeh, R. (2004) Guidelines for preventing health-care–associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep., 53, 1–36.
Valencia, M., Ferrer, M., Farre, R., Navajas, D., Badia, J.R., Nicolas, J.M. et al. (2007) Automatic control of tracheal tube cuff pressure in ventilated patients in semirecumbent position: a randomized trial. Crit Care Med., 35, 1543–1549. Read More
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