I have spent 25 years attempting to take research and theory across the fields of respiratory care, critical care, and anesthesia practice into daily practice. Reading “Ventilator-Associated Pneumonia: Risk Factors and Prevention” by Beth Augustyn in the August issue of Critical Care Nurse (August 2007:32–39) stimulated my critical assessment of how perioperative activities affect patient care.

I agree that interventions to prevent VAP should begin at the time of, or if possible, before intubation. For the thousands of surgical patients who will require critical care postoperatively, this can only happen with the cooperation and support of your institution’s anesthesia providers. As Augustyn stated, host risk factors can be identified well in advance, whereas device risk factors in surgical patients are relatively fixed.

A successful approach to VAP prevention as described will require a close collaboration among surgeons, anesthetists, and...

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