Thursday, November 5, 2015

Measures Approved In VAP Prevention

By Mattie Knight


There are substantial differences in prevention of Ventilator-associated pneumonia all over the globe with many of them emanating from differences in how medical literature is interpreted and also the medical practices employed. Strategies like maintenance of good hygiene have been reported to be very effective but the problem is that not many people use them. Thus, the discussion is dedicated on outlining strategies of VAP prevention.

Positioning the patient in semi-recumbent is crucial. Medical literature differs on the height of elevation with many quoting 30-45 degrees as the ideal height. However, there are others who do not agree with these figures. These differences have led to under-utilization of the strategy.

Experts in the medical field have urged care providers to make sure the bed is elevated despite the controversy surrounding the elevation degree. This is because even the slightest elevation has been shown to be effective as opposed to having the patient lie flat. To note is that the beds of patients who have severe hypotension, undergone brain surgery or have certain fractures are not to be raised.

Weaning assessment and sedation vacation are approaches which that have been commended in prevention of VAP too. It is a fact that patients who are extubated after a short while are less likely to suffer from VAP. Besides this, sedation vacations need to be timed. This involves withholding sedation drugs for a period of 6-8 hours every day if appropriate. This should be followed by spontaneous extubation and breathing trials conducted to assess whether the patient can maintain spontaneous breathing comfortably on his or her own.

Continuously removing subglottic secretion is very helpful to patients at risk of VAP. Tubes are employed in achieving this. There are new tubes which have been fitted with isolated dorsal lumen to make the suctioning process easier. Early-generation tubes were reported to malfunction frequently even though they were cheap. The newer ones are coated with silver and are sold at slightly higher prices but the degree of their effectiveness is worth the extra cost.

When using feeding tubes the oral ones are preferred than those passed via the nasal cavity. Though the evidence is inferential it has been shown that the nasal tubes contribute to development of sinusitis which is a major contributor to ventilator-associated pneumonia. They interfere with the normal sinus drainage leading to blockage and consequently infection.

Use of chlorhexidine gluconate in oral hygiene is a great approach too. Even though there is not much evidence in support of this, it has been reported to be very beneficial. Brushing the teeth, use of mouthwash and gum stimulation are procedures which are very easy not to mention that they do not cost much. Thus, health care providers should ensure that the patients benefit from this.

Provision of prophylaxis for stress ulcers has been recently cleared as an effective strategy in VAP avoidance. Sucrasulfate use has been confirmed to minimize VAP and gastric bleeding. Gastrointestinal bleeding is a major cause of ventilator-associated pneumonia though the mechanism through which this happens is not clearly outlined. Antacids, H2 blockers and PPIs produce a similar effect but research studies focusing on them have not received much attention.




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