fever, leukocytosis, progressiveinfiltrate on chest X-ray, positive cultures from respiratory secretions and reduction in gasexchange
Criteria for VAP * Fever * Leukocytosis * Increased chest infiltrate * Positive respiratory secretions * Decreased gas exchange
-BS-J
. Thirty-two studies measured the compliance to ventilator bundles and/or educationprogram, and in all of them there was a significant increase in VAP bundle adherence afterthe education program.
Education about bundles are an important component of success. -BS-J
TT cuff pressure at 20–30 cm H2O
ETT cuff pressure should be between 20-30 cm H20
PUD and DVT prophylaxis
Peptic ulcer disease and DVT prophylaxis is an important component of reducing VAP. - BS-J
In two studies, oneadditional preventive measure was selective oropharyngeal decontamination by using colistin,tobramycin, and nystatin, three times daily, with remarkable VAP reduction rates [
Oropharyngeal decontamination 3x daily decreases VAP
The most commonbias in the pre-post observational studies was the bias due to deviations from intendedinterventions
Interesting -BS-J
(1) elevation of the headof bed (HOB) to 30◦–45◦; (2) daily “sedation vacation” and assessment o
IHI Ventilator Bundle 1. Elevate HOB 30-45 degrees 2. Daily sedation vacation & reassessment for readiness to extubate 3. Peptic ulcer disease prophylaxis 4. DVT prophylaxis 5. Oral hygiene
-BS-J
“IHI Ventilator Bundle”,
IHI Ventilator is the most used bundle for the prevention of VAP -BS-J
Bundle is a set of individual components, combined to make a set of quality indicators for aspecific system, procedure, or treatmen
In hospitals, a bundle is set of interventions with quality indicators, procedures, and treatments used to solve a clinical problem. -BS-J
highest VAP reduction adoptedthe “IHI Ventilator Bundle” combined with adequate endotracheal tube cuff pressure and subglotticsuctioning.
IHI Ventilator Bundle, appropriate endotracheal tub cuff pressure, and subglottic suctioning were the three most successful techniques implemented to decrease VAP. -BS-J
Head-of-bedelevation was implemented by almost all studies
Semi-fowlers positioning and oral hygiene were notes to be the most common interventions implemented to prevent VAP. -BS-J
common risk
When deciding to place someone on a ventilator, it is important to discuss the possibility of VAP development, symptoms, the morbidity, and mortality rate of the disease process. All patients on a ventilator should have a bundle of practices in place to prevent the development of VAP.- BS-J