A simple program to reduce the incidence of ventilator-associated pneumonia in a Brazilian intensive care unit

Introduction

Ventilator-associated pneumonia (VAP) is very important in ventilated patients. There are many procedures (more or less 23) that could reduce VAP, but many of them are difficult or expensive to use.

Objectives

To evaluate the efficacy of three simple measures, the semi-recumbent position, 'clean' intubation and a protocol of tracheal aspiration, in the incidence of VAP.

Methods

Our ICU has 12 adult beds. The period was the year 2003 and 2004 until October. We standardized the semi-recumbent position at 45°, routine intubation and tracheal aspiration in all patients under mechanical ventilation. Nothing more changed. We compared the incidence of VAP in 2003 with the data from 2001, 2002 and 2004.

Results

Patients were similar by age, sex and APACHE II score. The incidence of VAP was 28 and 22 per 1000 patient-days of mechanical ventilation in 2001 and 2002. The incidence in 2003 was 10.7, almost 50% less than 2001/2002, and 7.4 in 2004. In a study we had done in 2002, we identified in 80% of opportunities that patients under mechanical ventilation were with the trunk below 45°.

Conclusion

To keep the patient under mechanical ventilation in a semi-recumbent position is not difficult, as to standardize intubation and tracheal aspiration. Unfortunately our doctors, nurses and respiratory therapists were not aware of these practices, although all of them know the rationale and advantages. With these simple and inexpensive measures, we could reduce significantly the incidence of VAP, around 50%. We must continue the study, with many cases, to confirm the results.