Pathogenic Mechanisms and Corresponding Prevention Strategies for Ventilator-Associated Pneumonia
| Pathogenic Mechanism | Prevention Strategy |
|---|---|
| Oropharyngeal colonization with pathogenic bacteria | |
| Elimination of normal flora | Avoidance of prolonged antibiotic courses |
| Large-volume oropharyngeal aspiration around time of intubation | Short course of prophylactic antibiotics for comatose ptsa |
| Gastroesophageal reflux | Postpyloric enteral feedingb; avoidance of high gastric residuals, prokinetic agents |
| Bacterial overgrowth of stomach | Avoidance of prophylactic agents that raise gastric pHb; selective decontamination of digestive tract with nonabsorbable antibioticsb |
| Cross-infection from other colonized pts | Hand washing, especially with alcohol-based hand rub; intensive infection control educationa; isolation; proper cleaning of reusable equipment |
| Large-volume aspiration | Endotracheal intubation; rapid-sequence intubation technique; avoidance of sedation; decompression of small-bowel obstruction |
| Microaspiration around endotracheal tube | |
| Endotracheal intubation | Noninvasive ventilationa |
| Prolonged duration of ventilation | Daily awakening from sedation,a weaning protocolsa |
| Abnormal swallowing function | Early percutaneous tracheostomya |
| Secretions pooled above endotracheal tube | Head of bed elevateda; continuous aspiration of subglottic secretions with specialized endotracheal tubea; avoidance of reintubation; minimization of sedation and pt transport |
| Altered lower respiratory host defenses | Tight glycemic controlb; lowering of hemoglobin transfusion threshold |
aStrategies demonstrated to be effective in at least one randomized controlled trial.
bStrategies with negative randomized trials or conflicting results.