Ventilator-associated pneumonia: The potential critical role of emergency medicine in prevention

Mary Jo Grap, Cindy L. Munro, Takeshi Unoki, V. Anne Hamilton, Kevin R. Ward

Research output: Contribution to journalArticle

22 Scopus citations

Abstract

Background: Delivery of critical care within a certain window of opportunity is paramount in many disease states, and providing the right care to these patients at the right time in the Emergency Department (ED) can significantly reduce mortality. However, aggressive treatment of these patients often requires endotracheal intubation and mechanical ventilation either in the pre-hospital or ED phase of care. Care of mechanically ventilated patients in the ED is not trivial or without potential complications, including ventilator-associated pneumonia (VAP). Objective/Discussion: This article summarizes the epidemiology, pathophysiology, and specific risk factors associated with VAP and provides evidence-based recommendations for its prevention. We emphasize practices that are particularly important in the early stages of care of intubated, mechanically ventilated patients; thus, they should be instituted in the ED. Conclusion: Specifically, we recommend continuous backrest elevation of 3045°, chlorhexidine application to the oral cavity after intubation and every 12 h thereafter, orotracheal intubation with a tube that enables continuous subglottic suctioning, and cuff pressure assessments after intubation and every 4 h thereafter to maintain pressure between 20 and 30 cm H 2O.

Original languageEnglish (US)
Pages (from-to)353-362
Number of pages10
JournalJournal of Emergency Medicine
Volume42
Issue number3
DOIs
StatePublished - Mar 1 2012
Externally publishedYes

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Keywords

  • backrest elevation
  • chlorhexidine
  • oral care
  • prevention
  • ventilator-associated pneumonia

ASJC Scopus subject areas

  • Emergency Medicine

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