Notes when taking care of patients with ventilator-associated pneumonia

This is an automatically translated article.

The article was professionally consulted by Doctor Tran Thi Diem Trang - Respiratory Internal Medicine Doctor - Department of Medical Examination & Internal Medicine - Vinmec Central Park International General Hospital.
The article is professionally consulted by Master, Doctor Nguyen Huy Nhat - Department of Medical Examination & Internal Medicine - Vinmec Da Nang International General Hospital.
Ventilator Associated Pneumonia (VAP) is a common complication in the intensive care units, pneumonia appears 48 hours after the patient is intubated and artificially ventilated.

1. Risk factors for ventilator-associated pneumonia

Risk factors for ventilator-associated pneumonia can be classified into the following groups:
1.1 Patient's intrinsic factors Age. Nutritional status. The underlying disease is too severe. Chronic lung disease. Severe head injury. Chest or upper abdominal surgery. Prolonged use of immunosuppressive drugs. Stress ulcer with gross bleeding. 1.2 Hospital factors Long-term Bacbiturate treatment. Treatment to suppress gastric acid. Prolonged antibiotic therapy. Prolonged artificial ventilation. Absorb phlegm regularly. The hospital's anti-infective status did not meet the standard. 1.3 Instruments used in the treatment of Intubation or the patient self-extracting the endotracheal tube. Bronchoscopy. Gastric tube placement: The catheter increases parasitic microorganisms in the nose and pharynx, causing reflux of gastric juice, bacteria from the stomach through the tube to the upper respiratory tract. Factors that increase the level of aspiration into the respiratory tract such as: Decreased consciousness, use of sedatives, continuous muscle relaxants, supine position.

2. Prevention of ventilator-associated pneumonia

2.1. Aspiration pneumonia Prefer non-invasive ventilation if no contraindications Shorten the duration of artificial ventilation Subglottic sputum aspiration Place patient in a supine position with head elevated (semirecumbent) 30- 45 degrees if no contraindications Use a sterile sputum suction tube for each suction or a closed sputum suction system if possible. Ideally, each straw should only be inserted into the airway once. Use sterile water to clean the secretions of the sputum suction tube during suction. Do not pump water in before suction. Change the suction hose to the suction hose every day or when used on another patient. Change suction flask every 4 hours and change when used in another patient unless used for a short period of time (eg, postoperative patients) Avoid spontaneous extubation Maintain optimal cuff pressure Avoid strain Excessive gastric dilatation Avoid unnecessary tubing changes Avoid airway stagnation Avoid unnecessarily transporting the patient

2.2 Pneumonia caused by resident bacteria that cause disease Routine hand washing with correct technique: Healthcare workers caring for sick people need to follow the 5 times of hand hygiene recommended by the World Health Organization: After contact with mucous membranes, respiratory secretions or objects contaminated with respiratory secretions with or without gloves, before and after contact with an intubated or tracheostomy patient, before and after come into contact with any breathing apparatus used on the sick person. Train and ensure a sufficient number of staff, especially nurses, pay attention to oral hygiene care: Clean teeth with an antiseptic solution, preferably Chlorhexidine 0.12%. If using a brush, take care of your teeth twice a day; If you only use gauze, take care of your teeth every 2-4 hours. Avoid unnecessary stress-induced peptic ulcers Prophylaxis with sucralfate Oral intubation Avoid antibiotics if not necessary Use antibiotics for the shortest possible time, National General Hospital Vinmec Hospital is one of the hospitals that not only ensures professional quality with a team of leading medical doctors, modern equipment and technology, but also stands out for its comprehensive medical examination, consultation and treatment services. , professional; civilized, polite, safe and sterile medical examination and treatment space.

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