Prevention

VAP is an iatrogenic infection that, in ARDS patients, impairs morbidity and constitutes an important burden for the healthcare system. Therefore, preventive strategies should be applied to avoid the disease. To date, several preventive measures are available for all mechanically ventilated patients and are often grouped as a bundle

Table 20.2 Preventive bundle

Implementation of educational programs for caregivers and frequent performance feedbacks and compliance assessment Strict alcohol-based hand hygiene

Daily sedation vacation and implementation of weaning protocols

No ventilatory circuit tube changes unless the circuit is soiled or damaged

Use of tracheal tube with cuff made of novel materials

Use of silver-coated tracheal tube

Application of low-level PEEP during tracheal intubation

Aspiration of subglottic secretions

Internal cuff pressure maintained within the recommended range and carefully controlled during transport of patients outside ICU

Oral care with chlorhexidine

Avoid stress ulcer prophylaxis in very low-risk patients for gastrointestinal bleed, and consider the use of sucralfate when indicated

Semirecumbent patient positioning

SDD for patients requiring >48 h of mechanical ventilation

ICU intensive care unit, PEEP positive end-expiratory pressure, SDD selective digestive decontamination

(Table 20.2). Nevertheless, in the next paragraphs, the most important strategies aimed at preventing VAP in ARDS patients will be highlighted.