ombined with adequate ETT cuff pressure and subglotticsuctioning, without forgetting the hand hygiene and aseptic suctioning technique. ICUsshould adopt basic practices that prevent or decrease VAP rates, and as a result, mortality,duration of mechanical ventilation, length of stay, and healthcare costs. Moreover, thestrategies should be multifaceted and supported by a long-term education program byensuring compliance in the care bundle.

The studies with the highest rate of reduction [ 5, 19,25 ] implemented the “IHI Ventila-tor Bundle” combined with adequate ETT cuff pressure at 20–30 cm H2O and subglotticsuctioning.

The total sample size rangedfrom 43 intubated patients [20 ] to 171,237 intubated patients [ 21]. All the studies, due tothe inclusion criteria, had a pre- and post-intervention observational study design. Thestudied populations were critically ill ventilated patients admitted to general, medical,surgical, neurosurgical, trauma, and cardiovascular ICUs. Most of the included studieswere performed in general ICUs and fifteen of them were multicenter.

gram, and main findings. The appraisal of quality of the included studieswas performed by using the Risk of Bias in Non-randomized Studies of Interventions(ROBINS-I) [16]. The checklist consisted of seven domains of bias: confounding, partici-pants’ selection, interventions’ classification, deviation from intended interventions, miss-ing data, outcom

vention VAP rate; (e) compare with the individual intervention’s implementa-tion for VAP prevention; and (f) be published after the implementation of “IHI VentilatorBundle”. Additionally, we excluded protocols, conference papers, abstracts, posters, andletters to e

n the last two decades, a major problem has been the increasing rates of occurrence ofcommunity-associated methicillin resistant Staphylococcus aureus (CA-MRSA) and hospital-associated MRSA (HA-MRSA). Apart from that, the communities have faced several viraloutbreaks, such as SARS-1, SARS-2, and MERS. All the above severe respiratory syndromesand population aging have led to increased rates of ventilated patients [ 11 ]. As VAP is oneof the most common preventable lung infections in critically ill intubated patients, it isimperative to determine the most efficient preventive measures for VAP reduction.

here is no common bundle which can be agreed to be implemented bythe communities worldwide [10

“IHI Ventilator Bundle”, consisting of four elements: (1) elevation of the headof bed (HOB) to 30◦–45◦; (2) daily “sedation vacation” and assessment of readiness toAntibiotics 2023, 12, 227. https://doi.org/10.3390/antibiotics12020227 https://www.mdpi.com/journal/antibiotics

entilator-associated pneumonia (VAP) is one of the main types of infection in criticallyill mechanically ventilated patients, leading to increased mortality, morbidity, hospital stay,economic and psychological costs for patients and their families

The studies with the highest VAP reduction adoptedthe “IHI Ventilator Bundle” combined with adequate endotracheal tube cuff pressure and subglotticsuctioning. Multifaced techniques can lead to VAP reduction at a great extent. Multidisciplinarymeasures combined with long-lasting education programs and measurement of bundle’s complianceshould be the gold standard combination

Four studies indicated a low VAP reduction, while 22 studies found anover 36% VAP decline, and in ten of them, the decrease was over 65%

The most common interventions monitored in the care bundles were sedation andweaning protocols, semi-recumbent positioning, oral and hand hygiene, peptic ulcer disease anddeep venus thrombosis prophylaxis, subglottic suctioning, and cuff pressure control. Head-of-bedelevation was implemented by almost all studies, followed by oral hygiene, which was the secondextensively used intervention.

Ventilator-associated pneumonia (VAP) remains a common risk in mechanically ventilatedpatients. Different care bundles have been proposed to succeed VAP reduction.