Pathogenic Mechanisms and Corresponding Prevention Strategies for Ventilator-Associated Pneumonia

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Table 134-4

PATHOGENIC MECHANISM	PREVENTION STRATEGY
Pathogenic Mechanisms and Corresponding Prevention Strategies for Ventilator-Associated Pneumonia
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 pts^a
Gastroesophageal reflux	Postpyloric enteral feeding^b ; avoidance of high gastric residuals, prokinetic agents
Bacterial overgrowth of stomach	Avoidance of prophylactic agents that raise gastric pH^b ; selective decontamination of digestive tract with nonabsorbable antibiotics^b
Cross-infection from other colonized pts	Hand washing, especially with alcohol-based hand rub; intensive infection control education^a ; 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 ventilation^a
Prolonged duration of ventilation	Daily awakening from sedation,^a weaning protocols^a
Abnormal swallowing function	Early percutaneous tracheostomy^a
Secretions pooled above endotracheal tube	Head of bed elevated^a ; continuous aspiration of subglottic secretions with specialized endotracheal tube^a ; avoidance of reintubation; minimization of sedation and pt transport
Altered lower respiratory host defenses	Tight glycemic control^b ; lowering of hemoglobin transfusion threshold

^a Strategies demonstrated to be effective in at least one randomized controlled trial.

^b Strategies with negative randomized trials or conflicting results.