Table 13.3.

Prevention of VAP

Pharmacological methods	Non-pharmacological methods
1. Hand hygiene with alcohol based solution	1. Use of noninvasive mask ventilation
2. Oral care with chlorhexidine	2. Avoid reintubation
3. Short course of antibiotic therapy (when clinically applicable)	3. Orotracheal and orogastric intubation
4. Sedation control and weaning protocol Manage without sedation whenever possible/Interupt sedation daily	4. Use of heat moisture exchanger
5. Restricted blood transfusion	5. Closed endotracheal suction
6. Vaccines (influenza and pneumococcal) 7. Prophylactic probiotic	6. Subglottic secretion drainage 7. Automated control of endotracheal tube cuff pressure 8. Mechanical tooth brushing 9. Ultrathin polyurethane endotracheal tube cuff 10. Saline installation before endotracheal suctioning
	11. Change of ventilator circuit only for each new patient
	12. Semirecumbent positioning (elevate head end of bed 30–45°)
	13. Shortening duration of mechanical ventilation (assess readiness to extubate daily/perform spontaneous breathing trials with sedatives turned off/facilitate early mobility)
	14. Adequate intensive care staffing
	15. Use of protocol bundles
	16. Education and training