Critically ill patients who are intubated are at risk for development of ventilator-associated pneumonia (VAP). The National Healthcare Safety Network reported that the incidence of VAP for various types of hospital units is from 0.0 to 4.4 per 1000 ventilator days.1 Although reported incidence rates have been steadily declining, it remains unclear whether this decrease is related to prevention efforts, reporting definitions, or a combination of the two.
The mortality associated with VAP is significant. Published mortality rates are from 0% to 70%, depending on the population studied, clinical condition, and timing of VAP identification and antibiotic administration. More recent meta-analyses report VAP-attributable mortality rates between 4.4% and 13%.2–6
Collaborate to identify patients where implementation of noninvasive positive pressure ventilation (NIPPV) may be appropriate to prevent the need for intubation.7–9 [level C]
Assess readiness to extubate...