Table 1 Investigated preventative measures and methods to reduce ventilator-associated pneumonia targeting mechanisms related to tracheal seeding, microaspiration, biofilm formation, ciliary dysfunction, and cough reflex
Source | Tracheal seeding | Microaspiration | Biofilm formation | Ciliary dysfunction | Cough reflex |
|---|---|---|---|---|---|
Mechanism | Intubation advances oral and gastric contents into trachea | ETTs stent vocal cords open and oral secretions flow to distal airways by trickling through creases in ETT cuff | Biofilm embedded microbes are sources of embolic fragments that migrate to distal airway divisions | Low airway moisture causes ciliary dyskinesia, disrupting mucociliary clearance | ETT and sedation interfere with coughing and the cough reflex necessary for secretion clearance |
Prevention | Suction and avoid advancing debris through glottis | Maintain cuff pressure of 20–30 cm H2O | Avoid unnecessary suctioning and bronchoscopy | Ventilate with warmed, humidified gas | Extubate early and perform frequent interruptions in sedation |
Methods investigated | Û°Oral/dental care Û°Preintubation oral antiseptics | Û° Novel cuff technologies and materials Û° Continuous pressure cuff monitoring Û° Subglottic secretions drainage Û° Body position (lateral decub, prone, semi recumbent) | Û° Antimicrobial/antiseptic coated ETT Û° Antibiotic impregnated ETT Û° ETT cleaning devices | Û° Airway humidification Û° Cuffless ETT with novel sealing | Û° Artificial cough maneuver |