A Comprehensive Review of Ventilator-Associated Pneumonia: The Nurse's Role in Prevention and Management

Abstract

Ventilator-associated pneumonia (VAP) is a prevalent and serious nosocomial infection in intensive care units (ICUs), affecting mechanically ventilated patients. It is characterized by clinical signs of systemic infection, changes in sputum properties, and the identification of a causative microorganism post-intubation. VAP is categorized as early-onset or late-onset based on the timing of onset after intubation, with each type associated with different causative pathogens. The pathophysiology of VAP involves colonization of the respiratory and digestive tracts, followed by microaspiration of secretions. Diagnosis relies on the presence of new pulmonary infiltrates, respiratory decline, fever, and productive cough, along with microbiological evidence. Risk factors for VAP include host-related factors (e.g., immunosuppression, COPD), device-related factors (e.g., endotracheal tubes), and personnel-related factors (e.g., lapses in hygiene). Management of VAP focuses on appropriate antibiotic therapy tailored to individual risk factors and the timing of onset. Nurses play a crucial role in preventing VAP through evidence-based interventions such as stress ulcer prophylaxis, oral care with chlorhexidine, hand hygiene, use of endotracheal tubes with subglottic aspiration, maintaining proper endotracheal tube cuff pressure, and positioning patients in a semi-upright position. Implementing a comprehensive VAP prevention bundle has been shown to significantly reduce VAP incidence, antibiotic usage, and improve patient outcomes.