Health practitioners from different regions have held their differences when it comes to prevention of ventilator-associated pneumonia. This has stemmed from differences in interpretation of literature talking about it and even the medical practices put forth to cub the condition. Hand-washing is one of the easiest ways of preventing this condition but not many give it attention. Below is a discussion on VAP prevention.
Positioning the patient in semi-recumbent is crucial. Medical literature differs on the height of elevation with many quoting 30-45 degrees as the ideal height. However, there are others who do not agree with these figures. These differences have led to under-utilization of the strategy.
There is an exception to patients who have undergone neurosurgery and those having certain fractures. Experts emphasize the need for head elevation even if one is not sure just how high the elevation should be because at the end the patient stands to benefit even if the bed is just slightly raised.
Ventilator weaning assessment and sedatives withdrawals have been confirmed to be beneficial to ICU patients if done early enough. The sedatives should be withdrawn for at least six-eight hours daily and the patient assessed. If they can do without the drugs then they should be stopped. Extubation should be carried out as soon as the patient can maintain independent breathing. Breathing trials should be done once or twice in a day.
Continuous secretion removal is encouraged in lowering the risk of VAP too. The newer tubes which have dorsal lumen made separately allow easier suctioning. This new tubes are very expensive by the virtue of them being silver-coated. However, if a life can be saved by using this tube, the extra expenses are not an issue. The problem with the old generation tubes is that their probability of malfunctioning is high.
When using feeding tubes the oral ones are preferred than those passed via the nasal cavity. Though the evidence is inferential it has been shown that the nasal tubes contribute to development of sinusitis which is a major contributor to ventilator-associated pneumonia. They interfere with the normal sinus drainage leading to blockage and consequently infection.
Use of chlorhexidine gluconate in oral hygiene is a great approach too. Even though there is not much evidence in support of this, it has been reported to be very beneficial. Brushing the teeth, use of mouthwash and gum stimulation are procedures which are very easy not to mention that they do not cost much. Thus, health care providers should ensure that the patients benefit from this.
Prevention of stress ulcers by provision of prophylaxis is emphasized in the at-risk population. This prevents occurrence of gastric bleeding which leads to VAP. The exact mechanisms which lead to this are not well understood but linkages have been demonstrated. Sucrasulfate is the only ulcer medication which is has been used in clinical trials. Proton-pump inhibitors, antacids and H2 blockers have been used in clinical trials but the studies are underpowered.
Positioning the patient in semi-recumbent is crucial. Medical literature differs on the height of elevation with many quoting 30-45 degrees as the ideal height. However, there are others who do not agree with these figures. These differences have led to under-utilization of the strategy.
There is an exception to patients who have undergone neurosurgery and those having certain fractures. Experts emphasize the need for head elevation even if one is not sure just how high the elevation should be because at the end the patient stands to benefit even if the bed is just slightly raised.
Ventilator weaning assessment and sedatives withdrawals have been confirmed to be beneficial to ICU patients if done early enough. The sedatives should be withdrawn for at least six-eight hours daily and the patient assessed. If they can do without the drugs then they should be stopped. Extubation should be carried out as soon as the patient can maintain independent breathing. Breathing trials should be done once or twice in a day.
Continuous secretion removal is encouraged in lowering the risk of VAP too. The newer tubes which have dorsal lumen made separately allow easier suctioning. This new tubes are very expensive by the virtue of them being silver-coated. However, if a life can be saved by using this tube, the extra expenses are not an issue. The problem with the old generation tubes is that their probability of malfunctioning is high.
When using feeding tubes the oral ones are preferred than those passed via the nasal cavity. Though the evidence is inferential it has been shown that the nasal tubes contribute to development of sinusitis which is a major contributor to ventilator-associated pneumonia. They interfere with the normal sinus drainage leading to blockage and consequently infection.
Use of chlorhexidine gluconate in oral hygiene is a great approach too. Even though there is not much evidence in support of this, it has been reported to be very beneficial. Brushing the teeth, use of mouthwash and gum stimulation are procedures which are very easy not to mention that they do not cost much. Thus, health care providers should ensure that the patients benefit from this.
Prevention of stress ulcers by provision of prophylaxis is emphasized in the at-risk population. This prevents occurrence of gastric bleeding which leads to VAP. The exact mechanisms which lead to this are not well understood but linkages have been demonstrated. Sucrasulfate is the only ulcer medication which is has been used in clinical trials. Proton-pump inhibitors, antacids and H2 blockers have been used in clinical trials but the studies are underpowered.
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