Strategies for the Prevention of Ventilator-associated Pneumonia in the Intensive Care Units: A Review

Ventilator-Associated Pneumonia (VAP) accounts for 80%-90% of hospital-acquired pneumonia cases in Intensive Care Units (ICUs). VAP occurs 48-72 hours after intubation, and is observed in 27%-29% of patients with endotracheal tube, and its risk increases with the increase in the duration of mechanical ventilation. In this review study, papers published from 1996-2018 were used to investigate strategies for preventing VAP in ICU patients. For this purpose, English articles with full text available on ProQuest, SID, ScienceDirect, Google Scholar and Scopus databases were searched online using the keywords related to VAP and chest physiotherapy used in the title or abstract. A total of 50  articles (from 10 different countries) covering both qualitative and quantitative studies in Persian and English conducted the last 19 years (since 1999) were selected. Those which were not a review/research paper and their full text were unavailable were excluded from the review. Among nosocomial infections, VAP is the most common cause of death, and the leading cause of death in ICUs. Physical strategies with a significant effect on the reduction of VAP included: Orotracheal intubation, closed endotracheal suctioning, use of humidifier and moisturizer, and chest physiotherapy. Effective positional strategies were: the use of kinetic beds, semi-recumbent position (up to 45 degrees), and prone position. Effective medication strategy is the use of topical and intravenous antibiotic prophylaxis.