Intervention
• Use noninvasive positive pressure ventilation in selected populations (I)
• Manage patients without sedation whenever possible (II)
• Interrupt sedation daily (I)
• Assess readiness to extubate daily (I)
• Perform spontaneous breathing trials with sedatives turned off (I)
• Facilitate early mobility (II)
• Utilize endotracheal tubes with subglottic secretion drainage ports for patients
expected to require more than 48 or 72 hours of mechanical ventilation (II)
• Change the ventilator circuit only if visibly soiled or malfunctioning (I)
• Elevate the head of the bed to 30°-45° (I
a
)
• Selective oral or digestive decontamination (I
b
)
• Regular oral care with chlorhexidine (II)
• Prophylactic probiotics (II)
• Ultrathin polyurethane endotracheal tube cuffs (III)
• Automated control of endotracheal tube cuff pressure (III)
• Saline instillation before tracheal suctioning (III)
• Mechanical tooth brushing (III)
• Silver-coated endotracheal tubes (II)
• Kinetic beds (II)
• Prone positioning (II
c
)
• Stress ulcer prophylaxis (II)
• Early tracheotomy (I)
• Monitoring residual gastric volumes (II)
• Early parenteral nutrition (II)
• Closed/in-line endotracheal suctioning (II)
Î In addition, approximately 5%-10% of mechanically ventilated patients
develop other ventilator-associated events (VAEs). These include
acute respiratory distress syndrome, pneumothorax, pulmonary
embolism, lobar atelectasis, and pulmonary edema.
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