Ventilator-Associated Pneumonia
Table 4. Summary of Recommendations for Preventing
Ventilator-Associated Pneumonia (VAP) in
Adult Patients
Recommendation Rationale
Best practices Good evidence that the intervention decreases the average
duration of mechanical ventilation, length of stay, mortality,
and/or costs; benefits likely outweigh risks
Special approaches Good evidence that the intervention improves outcomes but
insufficient data available on possible risks
May lower VAP rates but insufficient data to determine impact
on duration of mechanical ventilation, length of stay, or
mortality
Generally NOT
recommended
Lowers VAP rates but ample data suggest no impact on duration
of mechanical ventilation, length of stay, or mortality
No impact on VAP rates, average duration of mechanical
ventilation, length of stay, or mortality
c
No recommendation No impact on VAP rates or other patient outcomes, unclear
impact on costs
a
ere are very few data on head-of-bed elevation, but it is classified as a basic practice because of its
simplicity, ubiquity, low cost, and potential benefit.
b
ere are abundant data on the benefits of digestive decontamination but insufficient data on the
long-term impact of this strateg y on antimicrobial resistance rates.
c
May be indicated for reasons other than VAP prevention.
Key Points
Î Although surveillance rates hover near zero, clinical surveys suggest
that 5%-15% of ventilated patients develop nosocomial pneumonias.
Î The attributable mortality of VAP is estimated to be approximately
10% but varies considerably for different kinds of patients.
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