Table 2. Recommendations to Prevent VAP in Preterm
Neonates
Essential Practices: confer minimal risk of harm and may lower VAP and/or
PedVAE rates
1. Use non-invasive positive pressure ventilation in selected populations. (H)
2. Minimize the duration of mechanical ventilation. (H)
3. Assess readiness to extubate daily. (L)
4. Manage patients without sedation whenever possible. (L)
5. Avoid unplanned extubation. (L)
6. Avoid reintubation by using nasal continuous positive airway pressure (CPAP),
NIPPV, or high flow nasal cannula in the post-extubation period. (H)
7. Provide regular oral care with sterile water. (L)
8. Minimize breaks in the ventilator circuit. (L)
9. Change the ventilator circuit only if visibly soiled or malfunctioning (or per
manufacturer's instructions). (L)
10. Use caffeine therapy to facilitate extubation. (H)
Additional Approaches: minimal risks of harm, but impact on VAP and VAE rates is
unknown
1. Lateral recumbent positioning. (L)
2. Reverse Trendelenberg positioning. (L)
3. Closed/in-line suctioning systems. (L)
4. Oral care with maternal colostrum. (M)
Approaches that Should Not be Considered a Routine Part of VAP Prevention
1. Regular oral care with antiseptics. (L)
2. Histamine-2 receptor antagonists. (M)
3. Prophylactic broad-spectrum antibiotics. (M)
4. Daily spontaneous breathing trials. (L)
5. Daily sedative interruptions. (L)
6. Prophylactic probiotics or synbiotics. (L)
Unresolved Issues
1. Endotracheal tubes with subglottic secretion drainage ports. (NA)
2. Silver-coated endotracheal tubes. (NA)
