1. Ventilator Associated Pneumonia

2. Ventilator-associated pneumonia (VAP) is a form of hospital-associated pneumonia (HAP) which develops in mechanically ventilated patients more than 48 hours after tracheal intubation. What is VAP?

3. Among ICU patients, nearly 90% of episodes of HAP occur during mechanical ventilation VAP occurs in 9-27% of all intubated patients VAP is the leading cause of nosocomial mortality (46%) and morbidity Mortality rate of ventilated patients who develop VAP is 44% higher than those who do not develop VAP What’s the fuss about VAP?

4. VAP incidence increases with duration of ventilator use (3% / day during first 5 days of ventilation) Half of all episodes of VAP occur within first 4 days of mechanical ventilation VAP prolongs ventilator time, length of ICU stay, and length of hospital stay VAP adds~$40,000 to hospital costs(USD)

5. 1. “Head of Bed” elevation –Elevation of the head of the bed (HOB) has been correlated with reduction in the rate of ventilator-associated pneumonia. –Aids ventilatory efforts and minimizes atelectasis. –Decreases risk of aspiration of gastric or oropharyngeal secretions.

6. 2. Daily “Sedation Vacation” and assessment of readiness to wean –Reducing the duration of mechanical ventilation decreases the risk of VAP. –Patients are assessed daily by discussing their sedation and giving them a Spontaneous Breathing Trial (SBT) –If the patient passes the SBT then they are determined to be ready for weaning from the ventilator.

7. 3. Use of oral gastric versus nasal gastric tubes Can reduce the risk of nosocomial sinusitis and possible VAP.

8. 4. EVAC Tubes for Intubation –The accumulation of contaminated oropharyngeal secretions above the Endotracheal tube cuff may contribute to the risk of aspiration. –Removal of these pooled secretions through suctioning, may reduce the risk for aspiration and VAP. –Requires the use of specially designed ETT’s, called EVAC tubes.

13. To Prevent Pneumonia the head of the bed has to be up 30 degrees!

14. Prevent Ventilator Associated Pneumonia Goal Reduce pneumonia that could occur while on a ventilator more than 2 days Four parts of our care to reach this goal 1. Raise the head of the bed 30 degrees or more. 2. See if the patient can breath on their own when waking up. 3. Use oral stomach tubes to prevent infection. 4. Use Special tubes for ventilation that also suction secretions.

17. It’s below 30 degrees outside….. Beat the bugs…Zap the VAP!

18. 30 Degrees?

19. THE RIGHT POSITION FOR RIGHT NOW

20. Keeping it up! Thanks to all ICU Staff % of Beds were elevated in 2010 Our VAP rate has decreased by % Prevent VAP with HOB 30 degrees