It is critical to ensure sterility and pathogen safety for patients in the clinical environment to prevent possible infections. This step is a necessary condition for the effectiveness of medical care because if these criteria are not met, the risk of harm to patient health increases. Ventilator-associated pneumonia (VAP) is one such example that occurs frequently. In general, VAP should be understood to mean conditions of pulmonary infection that develop in a patient while using ventilator-associated pneumonia. Thus, VAP should be classified as an unintentional clinical error and can be classified as healthcare-associated infections. The medical staff has no interest in developing such pathogenesis because it complicates the course of treatment of the patient in critical condition on the ventilator and has a destructive reputational potential for the clinic. In favor of this, preventive methodologies and techniques that can be used by clinical staff to reduce the likelihood of developing VAP need to be developed. The present research paper discusses this pathologic condition in detail and reviews fundamental techniques to minimize its development. In this respect, it explores the essence of VAP, diagnosis and confirmations and the preventive measures.
The Essence of VAP
One of the causes of increased mortality in intensive care units is ventilator-associated pneumonia. The ventilator plays a critical role for critically ill and vulnerable patients who are in a problematic condition and require artificial maintenance of lung function with pulmonary failure (Dumbre, 2019). Although the present procedure has many advantages in solving urgent clinical problems, the use of the ventilator entails some risks, among which special attention should be paid to the development of VAP (Wu et al., 2019). Infection of the lungs with pathogens occurs because of the intubated state of the patient, in which the airway disrupts the integrity of the mucous membranes, destroying the natural barriers to entry of infections (Potter et al., 2009). Many sources suggest that VAP is the cause of increased mortality among ventilator patients (Dumbre, 2019; Chacko et al., 2017; Cooper, 2021). According to the CDC, more than 300,000 patients are exposed to ventilation each year, and mortality among VAP-infected patients ranges from 24% in young adults to 60% in patients with acute lung injuries (NHSN, 2021). Thus, VAP is a severe threat to the clinical well-being due to the frequency of its manifestation in patients who require ventilation (Arumugam et al., 2018). Due to this reasoning, special and close attention is required.
Diagnosis and Confirmations
Diagnosis of VAP is complicated because of the unique features of this pathophysiological condition and inaccurate criteria for identification (Timsit et al., 2017). At the same time, it is expected that new technologies such as Artificial Intelligence and Machine Learning should help eliminate the problems of incorrect diagnoses and create an automated process for identifying and assessing the condition of patients (Frondelius et al., 2022). In this context, accurate diagnosis of this infection is a critical step since the earlier the infection is determined, the earlier the treatment starts (Frondelius et al., 2022). Additionally, the importance of considering the presence of ventilator-associated pneumonia in patients without obvious signs is emphasized (Fernando et al., 2020). There is evidence that the likelihood of VAP increases markedly in patients who have been on a ventilator for more than 48 hours, which means that quality pulmonary monitoring is needed primarily in such patients (Cooper, 2021; Chacko et al., 2017; Potter et al., 2009). However, according to the CDC, lung radiographs do not provide reliable results because of the subjectivity and variability of the findings (NHSN, 2021). One of the ways to diagnose this pathogenesis is by a culture of a lower airway scrape and microscopic observation of the specimen (Xu et al., 2019). Patients at risk should go through preventive measures to avoid getting sick. At the same time, none of the existing preventive measures guarantees the absence of the disease in the future (Timsit et al., 2017). Therefore, modern medicine does not have a complete solution, but continues to develop.
Based on the urgency of the problem, the academic medical community must take steps to find effective methodologies to combat VAP (Timsit et al., 2017). Nowadays, a lot of useful information and views with a solid evidence base have been accumulated within the scientific and scholarly materials mostly published by various institutions and journals (Alecrim et al., 2019). Recommendations are based on the use of different types of preventive measures to avoid or reduce the possibility of risk of developing ventilator-associated pneumonia. Additionally, there are different methods and strategies for dealing with such as hygiene with chlorhexidine and reduction of sedation whenever possible (Alecrim et al., 2019). An important area of preventive care is the treatment of the patient’s oral cavity (NHSN, 2021). Mechanical and pharmacologic oral cleansing is important in preventing VAP. This includes the use of special gels and solutions for oral decontamination or a combination thereof (Cooper, 2021). At the same time, supramental pressure testing and secretion aspiration to prevent forced aspiration have been effective measures (Miranda da Cruz & da Silva Martins, 2019). The CDC also recommends keeping the patient’s bed headboard at an angle of 30 to 45 degrees to prevent the settling of pathogens from the air (NHSN, 2021). Finally, it is impossible to achieve conditions of complete protection from infection in the absence of awareness of prevention methods. For example, only 56.7% of nurses in a survey study were fully informed about the essence of ventilator operation and the features of the procedure (Dumbre, 2019). Consequently, there is a gap between the prevention being developed and the degree of awareness of the problem, which means that staff needs to be trained effectively. Ultimately, all of the techniques described above can be useful with respect to minimizing the risk of VAP for ventilator patients.
One of the significant threats to the clinical well-being of critically ill patients with pulmonary failure is VAP. In general, the use of a ventilator is an excellent solution for critically ill patients. However, this procedure has side effects, among which pneumonia is of great importance. Additionally, there are difficulties in diagnosing VAP due to insufficiently accurate identification techniques. It is anticipated that technologies will develop in the future that will help to make more accurate diagnoses and therefore begin to apply preventive measures at an earlier stage. Along with preventive measures, there are strategies and methods for dealing with the diagnosis, such as sanitation and hygiene, oral care, supramental pressure testing, and staff training. VAP should be considered a side effect of ventilator use, resulting in disruption of the protective integrity of the airway mucosa. Ultimately, this will significantly reduce the risk of infection and thus prove to be a promising solution to the much-needed problem of pneumonia caused by the use of a ventilator.
Alecrim, R. X., Taminato, M., Belasco, A., Longo, M. C. B., Kusahara, D. M., & Fram, D. (2019). Strategies for preventing ventilator-associated pneumonia: An integrative review. Revista Brasileira de Enfermagem, 72, 521-530.
Arumugam, S. K., Mudali, I., Strandvik, G., El-Menyar, A., Al-Hassani, A., & Al-Thani, H. (2018). Risk factors for ventilator-associated pneumonia in trauma patients: A descriptive analysis. World Journal of Emergency Medicine, 9(3), 203. Web.
Chacko, R., Rajan, A., Lionel, P., Thilagavathi, M., Yadav, B., & Premkumar, J. (2017). Oral decontamination techniques and ventilator-associated pneumonia. British Journal of Nursing, 26(11), 594-599.
Cooper, A. S. (2021). Oral Hygiene care to prevent ventilator-associated pneumonia in critically ill patients. Critical Care Nurse, 41(4), 80-82.
Dumbre, D. U. (2019). A study to assess the knowledge and compliance of critical care nurses regarding ventilator care bundle in prevention of ventilator associated pneumonia. Medico Legal Update, 19(1), 176-178. Web.
Fernando, S.M., Tran, A., Cheng, W., Klompas, M., Kyeremanteng, K., Mehta, S., English, S.W., Muscedere, J., Cook, D.J., Torres, A., Ranzani, O.T., Fox-Robichaud, A. E., Alhazzani, W., Munshi, L., Guyatt, G. H., & Rochwerg, B. (2020). Diagnosis of ventilator-associated pneumonia in critically ill adult patients—a systematic review and meta-analysis. Intensive Care Medicine, 46(6), 1170-1179.
Frondelius, T., Atkova, I., Miettunen, J., Rello, J., & Jansson, M. M. (2022). Diagnostic and prognostic prediction models in ventilator-associated pneumonia: Systematic review and meta-analysis of prediction modelling studies. Journal of Critical Care, 67, 44-56.
Miranda da Cruz, J. R., & da Silva Martins, M. D. (2019). Pneumonia associated with invasive mechanical ventilation: Nursing care. Revista de Enfermagem Referência, 4(20).
NHSN. (2021). Ventilator-associated event (VAE). CDC.
Potter, P. A., Perry, A. G. E., Hall, A. E., & Stockert, P. A. (2021). Fundamentals of nursing(10thed.).
Timsit, J. F., Esaied, W., Neuville, M., Bouadma, L., & Mourvillier, B. (2017). Update on ventilator-associated pneumonia. F1000Research, 6, 1-13.
Wu, D., Wu, C., Zhang, S., & Zhong, Y. (2019). Risk factors of ventilator-associated pneumonia in critically III patients. Frontiers in Pharmacology, 10, 482.
Xu, Y., Lai, C., Xu, G., Meng, W., Zhang, J., Hou, H., & Pi, H. (2019). Risk factors of ventilator-associated pneumonia in elderly patients receiving mechanical ventilation. Clinical Interventions in Aging, 14, 1027.