The Most Recent Strategies for VAP (Ventilator-Associated Pneumonia) Prevention

Ventilator-associated pneumonia (VAP) is a complication that frequently affects mechanically ventilated patients worsening the outcome. This chapter is focused on the recent preventive measures. Many of these strategies have been incorporated into “VAP bundles,” a set of treatments implemented simultaneously to reduce VAP incidence. The VAP bundle, suggested by the Institute for Healthcare Improvement, includes three measures to directly prevent VAP, and two other meausures to prevent, respectively, the stress ulcer prophylaxis and deep venous thrombosis prophylaxis. Moreover, there are other recent preventive strategies based on the knowledge of the VAP pathogenesis. They can specifically affect the artificial airways or the daily caring of the mechanically ventilated patient. The continuous monitoring of endotracheal tube cuff pressure to reduce the aspiration of oropharyngeal secretions, the subglottic secretion drainage obtained by an endotracheal tube with a small suctioning port opening on the upper surface of the cuff, and the silver-coated endotracheal tubes to prevent the biofilm formation are innovative measures that have been demonstrated to reduce the VAP incidence. Generally, the oral care with chlorhexidine, the selective digestive decontamination, the early enteral feeding, the administration of probiotics, and the kinetic therapy are currently considered as measures of good clinical practice to improve the management of mechanically ventilated patients. We are waiting for the results of clinical trials to assess which is the patient position that can be associated with a lower incidence of VAP. Although some preventive strategies need to be validated in the context of clinical trials, implementation of preventive measures grouped into bundles can improve their efficacy.