Ventilator-associated pneumonia (VAP) is a major complication of mechanical ventilation. Much research has focused on how best to prevent VAP. The Institute for Healthcare Improvement includes the following components in its best-practices VAP prevention ¡°bundle¡±:

• Keep the head of the bed elevated 30 to 45 degrees at all times, if patient condition allows. Healthcare providers tend to overestimate bed elevation, so gauge it by looking at the bed frame rather than by simply estimating.
• Every day, provide sedation ¡°vacations¡± and assess readiness to extubate, indicated by vital signs and arterial blood gas values within normal ranges as well as the patient taking breaths on her own.
• Provide peptic ulcer disease prophylaxis, as with a histamine-2 blocker such as famotidine.
• Provide deep vein thrombosis prophylaxis, as with an intermittent compression device.
• Perform oral care with chlorhexidine daily.

Other measures that decrease VAP risk include extubating the patient as quickly as possible, performing range-of-motion exercises and patient turning and positioning to prevent the effects of muscle disuse, having the patient sit up when possible to improve gas exchange, and providing appropriate nutrition to prevent a catabolic state. Assess the patient¡¯s tolerance when she performs an activity by checking vital signs, oxygenation status, and pain and agitation levels.

Keeping bacteria out of oral secretions also reduces VAP risk. Use an endotracheal tube with a suction lumen above the endotracheal cuff to allow continuous suctioning of tracheal secretions that accumulate in the subglottic area. Don¡¯t routinely change the ventilator circuit or tubing. Brush the patient¡¯s teeth at least twice a day and provide oral moisturizers every 2 to 4 hours.