What are the CDC recommendations for preventing health-care associated pneumonia related to mechanical ventilation?

Updated: Apr 07, 2020
  • Author: Allon Amitai, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

The Centers for Disease Control and Prevention published Guidelines for Preventing Health-Care Associated Pneumonia in 2003, in which they recommend placing the patient in a semiupright position, with the head of the bed elevated 30-45o, in order to reduce the risk of aspiration. [28] Other measures such as early placement of a nasogastric tube and oral care with a soft toothbrush and chlorhexidine rinses may also be considered. [26] Lastly, endotracheal cuff pressures should be monitored initially after intubation and every 4 hours thereafter, with goal pressures of 20-30 cm water, as increased risk of pneumonia has been associated with cuff pressures less than 20 cm water.

In addition to VAP, mechanically ventilated ICU patients are also at high risk for development of VTE and stress-related injury of the gastrointestinal mucosa. In patients without contraindications, unfractionated or low-molecular-weight heparin should be considered in these patients for VTE prophylaxis. As the incidence of gastric mucosal erosions has been found to be greater than 75% in ICU patients within 24 hours of admission, gastrointestinal prophylaxis with a proton pump inhibitor, sucralfate, or histamine receptor antagonist should be considered in patients who are at high risk of gastrointestinal hemorrhage. [10] These high-risk patients have been identified as those with coagulopathy, history of gastrointestinal bleeding, history of gastritis or peptic ulcer, or mechanical ventilation for more than 48 hours.


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