The Ventilated Patient in ICU: Effective Patient Positioning in the Prevention of Ventilator Associated Pneumonia.
Ventilator Associated Pneumonia (VAP) continues to be a common and potentially fatal complication of ventilator care, often encountered within high tech, high touch environments characteristic of an Intensive Care Unit (ICU) (Sheila O’Keefe-McCarthy et al., 2008). Defined as pneumonia occurring in a patient within 48 hours or more after intubation with an endotracheal or tracheostomy tube, which was not present before, VAP is the most common and fatal infection of ICU. It increases stay by 28% and each incidence is estimated to generate an additional cost of £6,000 - £22,000 (Wagh et al., 2009). Reducing mortality due to Ventilator Associated Pneumonia requires an organised process that guarantees early recognition of pneumonia and consistent application of the best evidence-based practices. In 2006 leaders at the Institution for Health Improvement (IHI) derived the Ventilator Bundle (Appendix 1) consisting of a series of interventions related to ventilator care that, when implemented together, will achieve significantly better outcomes than when implemented individually (IHI, 2010). One significant intervention of the Ventilator Bundle concentrates on patient positioning or, to be precise, elevation of the head of the bed, at the recommended acclivity of at least 30 degrees. This paper aims to present a brief overview of the etiology of VAP, the Ventilator Bundle and an in depth analysis concentrating on the positioning of the ICU patient in relation to the prevention of Ventilator Associated Pneumonia and current practice.
Etiology of Ventilator Associated Pneumonia
Intubation impedes the body’s natural defence against respiratory infections. The placement of an endotracheal tube negates cough reflexes that protect the airway from invasive pathogens. Ventilation, through the placement of an endotracheal tube, prevents...
References: * O’Keefe-McCarthy S, Santiago C, Lau G. 2008. Ventilator-Associated Pneumonia Bundled Strategies: An Evidence-Based Practice. Worldviews on Evidence-Based Nursing, Fourth Quarter, pp.193-204.
* Wagh H, Acharya D. 2009. Ventilator Associated Pneumonia – an Overview. British Journal of Medical Practitioners, 2 (2) June, pp16-19.
* Institution for Health Improvement. 2010. Implement the Ventilator Bundle: Elevation of the Head of the Bed. [online] Available at: http://www.ihi.org/IHI/Topics/CriticalCare/IntensiveCare/Changes/IndividualChanges/Elevationoftheheadofthebed.htm [Accessed December 4 2010]
* Vincent J.L. 2004. Ventilator Associated Pneumonia. Journal of Hospital Infection, 57 (4) August, pp 272-280.
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