Impact of a Protocol for Prevention of Ventilator-Associated Pneumonia

Ventilator-associated pneumonia (VAP)is the most common nosocomial in-fection among patients requiring me-chanical ventilation.1 The development of VAP is associated with significant morbidity and mortality.1,2 According to the National Nosocomial Infections Sur-veillance (NNIS) system report, the mean incidence of VAP in a medical in-tensive care unit (ICU) is 7.3 episodes per 1000 ventilator-days, whereas the mean incidence in a surgical or trauma ICU reaches 13.2 and 16.2, respectively.3 VAP occurs more than 48 hours fol-lowing intubation and the start of me-chanical ventilation.4 Early-onset VAP typically occurs within 4 days of endotra-cheal intubation and is caused by antibiot-ic-sensitive pathogens, provided that no other risk factors for multidrug-resistant pathogens are present.4,5 Late-onset VAP occurs 5 or more days after mechanical ventilation is initiated and is usually asso-ciated with antibiotic-resistant pathogens.4 Its pathogenesis involves bacterial colo-nization of the upper respiratory tract and subsequent aspiration. Risk factors for VAP can be classified as modifiable (eg, gastric residuals>200 mL, achlorhydria, sinusitis, histamine2-antagonist use, dura-tion of mechanical ventilation>2 days, supine position, use of antibiotics, frequent changes of ventilator circuit, reintubation, nasogastric tube, nasotracheal intubation, paralytic agents, continuous infusion of sedatives) or nonmodifiable (eg, age, male sex, coma, severity of illness, trauma, burns, preexisting pulmonary dis-ease, altered level of consciousness).4,6 Given the consequences of a VAP episode, implemen-tion of preventive measures is justified. All intervention