Monday, November 9, 2015
Health professionals have had their differences when it comes to prevention of VAP. Medical literature focusing on prevention of this condition is interpreted differently amongst the professionals and a debate has ensued on the medical practices effective in VAP prevention.
The first one is semi-recumbent positioning. Elevation of the head in ICU patients is strongly supported in all medical textbooks and journal. However, it has been noted that the approach is not used by many care givers. The trend is linked to the debate on the degree of elevation with some saying that a minimum elevation of thirty degrees and a maximum of forty degrees is enough.
There is an exception to patients who have undergone neurosurgery and those having certain fractures. Experts emphasize the need for head elevation even if one is not sure just how high the elevation should be because at the end the patient stands to benefit even if the bed is just slightly raised.
Weaning assessment and sedation vacation are approaches which that have been commended in prevention of VAP too. It is a fact that patients who are extubated after a short while are less likely to suffer from VAP. Besides this, sedation vacations need to be timed. This involves withholding sedation drugs for a period of 6-8 hours every day if appropriate. This should be followed by spontaneous extubation and breathing trials conducted to assess whether the patient can maintain spontaneous breathing comfortably on his or her own.
Continuously removing secretions as they form is important too for patients at risk of developing this condition. There are new tubes in the market which have been made specifically for this purpose. They are far much better that the previous ones because they even have separately fitted dorsal lumens just over the cuff to make the suctioning process easy. Even though they cost more, their benefits are much compared to the cost.
Oral tubes are beneficial than nasal ones in Ventilator-associated pneumonia prevention. The nasally inserted tubes lead to sinus blockage which interferes with their drainage. If secretions remain there for long, they are likely to get infected and this is a major contributor to VAP. Nasal tubes should only be used in special cases when oral tubes are contraindicated.
Using chlorhexidine in oral hygiene has been termed as beneficial in pneumonia prevention in patients on a ventilator. The literature focusing on this does not explain the mechanism of action of this measures but its benefits have been confirmed though research. All that has to be done is gum stimulation, oral washes and brushing the teeth using this solution. The practices are not expensive and they take a very short time. Care providers should do this for the benefit of their patients.
Provision of prophylaxis for stress ulcers has been recently cleared as an effective strategy in VAP avoidance. Sucrasulfate use has been confirmed to minimize VAP and gastric bleeding. Gastrointestinal bleeding is a major cause of ventilator-associated pneumonia though the mechanism through which this happens is not clearly outlined. Antacids, H2 blockers and PPIs produce a similar effect but research studies focusing on them have not received much attention.
The first one is semi-recumbent positioning. Elevation of the head in ICU patients is strongly supported in all medical textbooks and journal. However, it has been noted that the approach is not used by many care givers. The trend is linked to the debate on the degree of elevation with some saying that a minimum elevation of thirty degrees and a maximum of forty degrees is enough.
There is an exception to patients who have undergone neurosurgery and those having certain fractures. Experts emphasize the need for head elevation even if one is not sure just how high the elevation should be because at the end the patient stands to benefit even if the bed is just slightly raised.
Weaning assessment and sedation vacation are approaches which that have been commended in prevention of VAP too. It is a fact that patients who are extubated after a short while are less likely to suffer from VAP. Besides this, sedation vacations need to be timed. This involves withholding sedation drugs for a period of 6-8 hours every day if appropriate. This should be followed by spontaneous extubation and breathing trials conducted to assess whether the patient can maintain spontaneous breathing comfortably on his or her own.
Continuously removing secretions as they form is important too for patients at risk of developing this condition. There are new tubes in the market which have been made specifically for this purpose. They are far much better that the previous ones because they even have separately fitted dorsal lumens just over the cuff to make the suctioning process easy. Even though they cost more, their benefits are much compared to the cost.
Oral tubes are beneficial than nasal ones in Ventilator-associated pneumonia prevention. The nasally inserted tubes lead to sinus blockage which interferes with their drainage. If secretions remain there for long, they are likely to get infected and this is a major contributor to VAP. Nasal tubes should only be used in special cases when oral tubes are contraindicated.
Using chlorhexidine in oral hygiene has been termed as beneficial in pneumonia prevention in patients on a ventilator. The literature focusing on this does not explain the mechanism of action of this measures but its benefits have been confirmed though research. All that has to be done is gum stimulation, oral washes and brushing the teeth using this solution. The practices are not expensive and they take a very short time. Care providers should do this for the benefit of their patients.
Provision of prophylaxis for stress ulcers has been recently cleared as an effective strategy in VAP avoidance. Sucrasulfate use has been confirmed to minimize VAP and gastric bleeding. Gastrointestinal bleeding is a major cause of ventilator-associated pneumonia though the mechanism through which this happens is not clearly outlined. Antacids, H2 blockers and PPIs produce a similar effect but research studies focusing on them have not received much attention.