Recommendations
Table 1. Recommendations to Prevent VAP in Adult Patients
Essential Practices: interventions with little risk of harm and that are associated with
decreases in duration of mechanical ventilation, length of stay, mortality, antibiotic
utilization, and/or costs
1. Avoid intubation and prevent reintubation if possible. (H)
a. Use high flow nasal oxygen or non-invasive positive pressure (NIPPV)
ventilation whenever safe and feasible.
2. Minimize sedation. (H)
a. Minimize sedation of ventilated patients whenever possible.
b. Preferentially use multimodal strategies and medications other than
benzodiazepines to manage agitation.
c. Utilize a protocol to minimize sedation.
d. Implement a ventilator liberation protocol.
3. Maintain and improve physical conditioning. Provide early exercise and mobilization.
(M)
4. Elevate the head of the bed to 30–45º .
a
(L)
5. Provide oral care with toothbrushing but without chlorhexidine. (M)
6. Provide early enteral rather than parenteral nutrition. (H)
7. Change the ventilator circuit only if visibly soiled or malfunctioning (or per
manufacturers' instructions). (H)
Additional Approaches: may decrease duration of mechanical ventilation, length of
stay, and/or mortality in some populations but not in others, and may confer some risk
of harm in some populations
1. Consider using selective decontamination of the oropharynx and digestive tract
to decrease microbial burden in ICUs with low prevalence of antibiotic resistant
organisms. Antimicrobial decontamination is not recommended in countries,
regions, or ICUs with high prevalence of antibiotic-resistant organisms. (H)
Additional Approaches: may lower VAP rates, but current data are insufficient to
determine their impact on duration of mechanical ventilation, length of stay, and
mortality
1. Consider utilizing endotracheal tubes with subglottic secretion drainage ports to
minimize pooling of secretions above the endotracheal cuff for patients likely to
require >48–72 hours of intubation. (M)
2. Consider early tracheostomy. (M)
3. Consider post-pyloric feeding tube placement in patients with gastric feeding
intolerance or at high risk for aspiration. (M)
