Reduce Oropharyngeal Colonization

VAP-reduction interventions generally focus on either reducing oropharyngeal colonization or preventing aspiration of colonized secretions

1. Peptic Ulcer Disease (PUD) Prophylaxis

Risk factors for VAP include:

  • H2 antagonists
  • Antacids

This is because they decrease intragastric acidity, which can result in greater colonization of pathogenic bacteria.([FOOTNOTE=American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388-416.],[ANCHOR=View Abstract],[LINK=/content/covidien/websites/medtronic/com/en/covidien/support/clinical-evidence.html?id=805217]) However, clinical trials investigating alternative therapies have been inconclusive regarding the prevention of VAP.1 The American Thoracic Society suggests that the risks and benefits of PUD prophylaxis regimens should be weighed before prescribing.1

2. Daily Oral Care with Chlorhexidine

Oral care is designed to reduce VAP by reducing oropharyngeal bacterial colonization.([FOOTNOTE=Labeau SO, Van de Vyver K, Brusselaers N, Vogelaers D, Blot SI. Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis. Lancet Infect Dis. 2011;11(11):845-854.],[ANCHOR=View Abstract],[LINK=/content/covidien/websites/medtronic/com/en/covidien/support/clinical-evidence.html?id=805233])

3. Selective Decontamination of the Digestive Tract

Gram-negative bacterial colonization of the stomach during critical illness is considered to be the source of microorganisms isolated from sputum cultures of patients with VAP.([FOOTNOTE= Liberati A, D'Amico R, Pifferi S, Torri V, Brazzi L, Parmelli E. Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care. Cochrane Database Syst Rev. 2009(4):CD000022.],[ANCHOR=View Abstract],[LINK=/content/covidien/websites/medtronic/com/en/covidien/support/clinical-evidence.html?id=805230]) Selective decontamination of the digestive track (SDD) uses prophylactic antibiotic therapy to reduce bacterial colonization.3

4. Silver-Coated Endotracheal Tubes (ETT)

Biofilm on the endotracheal tube (ETT) is considered to be a source of reinfection in patients with VAP.([FOOTNOTE=Gil-Perotin S, Ramirez P, Marti V, et al. Implications of endotracheal tube biofilm in ventilator-associated pneumonia response: a state of concept. Crit Care. 2012;23;16(3):R93. [Epub ahead of print]],[ANCHOR=View Abstract],[LINK=/content/covidien/websites/medtronic/com/en/covidien/support/clinical-evidence.html?id=412902]) Silver has a very effective broad-spectrum antimicrobial effect and is believed to reduce biofilm on endotracheal tubes.([FOOTNOTE=Kollef MH, Afessa B, Anzueto A, et al. Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial. JAMA. 2008;300(7):805-813.],[ANCHOR=View Abstract],[LINK=/content/covidien/websites/medtronic/com/en/covidien/support/clinical-evidence.html?id=231680])

5. Semirecumbent Position

This method is typically defined as raising the head of the bed to an angle of 30-45 degrees, and is thought to reduce VAP by decreasing the migration of gastric pathogens into the subglottic space.([FOOTNOTE=Niël-Weise BS, Gastmeier P, Kola A, Vonberg RP, Wille JC, van den Broek PJ. An evidence-based recommendation on bed head elevation for mechanically ventilated patients. Crit Care. 2011;15(2):R111.],[ANCHOR=View Abstract],[LINK=/content/covidien/websites/medtronic/com/en/covidien/support/clinical-evidence.html?id=805232])

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Efficacy of VAP Interventions that Target Oropharyngeal Colonization

1. Meta-analysis (14 studies, 2,481 participants) (P= 0.004)2

2. Randomized controlled trial (1,200 participants) (P=0.19)([FOOTNOTE=Cook D, Guyatt G, Marshall J, et al. A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. Canadian Critical Care Trials Group. N Engl J Med. 1998; 19;338(12):791-797.],[ANCHOR=View Abstract],[LINK=/content/covidien/websites/medtronic/com/en/covidien/support/clinical-evidence.html?id=97565])

3. Meta-analysis (33 studies, 5,697 participants) 3

4. Randomized controlled trial (1,509 participants) (P=0.03)5

View the Efficacy of VAP Interventions that Target Oropharyngeal Colonization table

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