ABSTRACT
Ventilator-associated pneumonia (VAP) is the most frequently occurring nosocomial infection among mechanically ventilated patients and has been associated with increased morbidity, attributable mortality, and higher health care related costs. As a result, preventive strategies for VAP have been a subject of extensive study over the last 30-plus years. These strategies can be viewed in five categories: (a) those reducing bacterial colonization by using antimicrobial agents (such as selective decontamination of the digestive tract [SDD], oropharyngeal decontamination or systemic antimicrobial prophylaxis) or other measures (such as sucralfate and acidified enteral feeding to maintain low gastric pH); (b) those aiming to reduce the risk of aspiration (such as subglottic aspiration and semirecumbent patient positioning); (c) those improving host defense (see Chapter 15); (4) those improving general infection control measures to limit cross-infection risks and (5) those reducing risk of contamination of the patients’ inanimate environment. In this
chapter, we focus on the potential benefits and risks of preventive strategies aimed at modulating colonization and reducing aspiration.
