Essential aspects of the prevention of ventilator-associated pneumonia: A State-of-the-Art Review.

BACKGROUND

Ventilator-associated pneumonia (VAP) is a major cause of morbidity and mortality in the ICU and is associated with high antibiotic consumption and increased healthcare resource utilization.

OBJECTIVES

This review provides an updated overview of current strategies for VAP prevention.

METHODS

A narrative review of the literature was conducted, including randomized controlled trials, systematic reviews, meta-analyses, and recent international guidelines and position papers on VAP prevention.

RESULTS

Successful VAP prevention depends on both effective implementation strategies and evidence-based clinical interventions. Current preventive measures target the main mechanisms involved in VAP pathogenesis, including prolonged mechanical ventilation, microaspiration, endotracheal tube biofilm formation, and colonization of the aerodigestive tract. Routine preventive measures with the strongest supporting evidence include minimizing the duration of mechanical ventilation and sedation, avoiding unnecessary intubation and re-intubation, semi-recumbent positioning, oral care with toothbrushing rather than chlorhexidine, early enteral nutrition, and the use of structured prevention bundles. Additional interventions, such as subglottic secretion drainage, selective digestive or oropharyngeal decontamination, inhaled antibiotics, early tracheostomy, and post-pyloric feeding, may be beneficial in appropriately selected patients or specific clinical settings. In contrast, some interventions have inconsistent evidence of clinical benefit and are not recommended for routine use.

CONCLUSIONS

Preventing VAP requires a multimodal approach that integrates organizational support with evidence-based preventive measures. As new evidence continues to emerge, prevention bundles should be regularly updated to optimize effectiveness while avoiding interventions that are ineffective or potentially harmful.

IMPLICATIONS FOR CLINICAL PRACTICE: Implementation of VAP prevention strategies should focus on interventions supported by the best available evidence, while tailoring selected strategies to local epidemiology, available resources, and individual patient characteristics. Consistent adherence to multidisciplinary prevention bundles remains fundamental for reducing the burden of VAP.