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

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

Research output: Contribution to journalArticle

20 Citations (Scopus)

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

Fingerprint

Ventilator-Associated Pneumonia
Emergency Medicine
Hospital Emergency Service
Intubation
Pressure
Chlorhexidine
Intratracheal Intubation
Hospital Departments
Patient Rights
Critical Care
Artificial Respiration
Mouth
Epidemiology
Mortality
Therapeutics

Keywords

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

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Ventilator-associated pneumonia : The potential critical role of emergency medicine in prevention. / Grap, Mary Jo; Munro, Cindy; Unoki, Takeshi; Hamilton, V. Anne; Ward, Kevin R.

In: Journal of Emergency Medicine, Vol. 42, No. 3, 01.03.2012, p. 353-362.

Research output: Contribution to journalArticle

Grap, Mary Jo ; Munro, Cindy ; Unoki, Takeshi ; Hamilton, V. Anne ; Ward, Kevin R. / Ventilator-associated pneumonia : The potential critical role of emergency medicine in prevention. In: Journal of Emergency Medicine. 2012 ; Vol. 42, No. 3. pp. 353-362.
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