Mechanical Ventilation- Ventilator Associated Pneumonia
The most common cause of ventilator-associated pneumonia (VAP) is not the ventilator itself but rather the oral secretions from the patient which are then aspirated into the airways.
The organisms causing a VAP can arise from either the ventilator circuit or, as already said, from aspirations of secretions from above the endo tracheal tube.
Aspiration can occur due to the development of longitudinal folds in the endotracheal tube which allows leakage from above to below.
Therefore one way to avoid a VAP is to minimise the secretions which might collect above the cuff.
Hand hygiene and related precautions
Good hand hygiene and the wearing of gloves will help ensure that there is minimal transfer of bacteria from one patient to another for example.
Ventilated patients should be nursed at 30 degrees or more to help prevent reflux of gastric contents and subsequent reflux.
Using NIV reduces the risks of a VAP so should be considered whenever possible.
Duration of mechanical ventilation
Daily awakening trials and spontaneous breathing trails should be used to try to minimise the length of time the patient is on the ventilator.
Care of ventilator circuit
Circuits do not need to be changed routinely and inline suctioning should be used to minimise the breaking of the circuit.
The use of PEEP has been shown to reduce VAP
- Peak and Plateau Pressure
- AC versus SIMV mode
- Positive End Expiratory Pressure (PEEP)
- Increase the rate or tidal volume?
- Phases of a breath- I:E ratio and cycle time
- Ventilation screen- what do those numbers mean?
- Pressure Support
- Modes of ventilation I
- Modes of ventilation II
- Physiologic effects
- Physiologic goals
- How do I describe how my patients ventilation?
- Trigger, Limit and Cycle
- Pressure support ventilation graphs
- 6 ways to be better with Bag-Valve-Mask
- Phase Variables
- Airway Pressure Release Ventilation (APRV)
- Pressure Volume Loop
- Lung compliance in volume controlled ventilation
- Pressure/Volume/Flow graphs
- A-a gradient
- Goals and Indications
- Anatomy of the Endotracheal Tube
- Lung Compliance
- Ventilation/Perfusion V/Q matching
- Ventilator Induced Lung Injury (VILI)
- Ventilator Associated Pneumonia (VAP)
- Phase variables...again...
Guidelines for the management of tracheal intubation in critically ill adults
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