Non-invasive ventilation and early mobilization improves VAP prevention: Study

A recent study published in the Journal of Hospital Infection found selective decontamination of the digestive tract (SDD) and the non-invasive ventilation (NIV) use to protect against Ventilator-Associated Pneumonia (VAP) which is a significant threat to critically ill patients on mechanical ventilation.

The comprehensive analysis reviewed a total of 34 interventions across 31 studies and identified the key strategies to reduce the incidence of VAP in intensive care practices. VAP poses a formidable challenge in critical care, with its incidence directly impacting the patient outcomes and healthcare costs. The meticulous review of randomized and quasi-randomized controlled trials revealed that 19 of the total interventions studied markedly reduced VAP incidents. This study highlighted the effectiveness of selective decontamination of the digestive tract and the use of non-invasive ventilation in weaning patients from mechanical ventilation as the most promising preventive measures.

SDD involved the application of topical antibiotics in the oropharynx and gastrointestinal tract and was backed by highly suggestive (Class II) evidence showing a risk ratio (RR) of 0.439. This indicates a significant reduction in VAP rates among the patients receiving SDD when compared to the individuals who did not. Also, NIV showed a compelling reduction in VAP incidence, with its evidence strength upgraded to highly suggestive (Class II) based on a risk ratio of 0.32 that highlights its efficacy in safely reducing the duration of mechanical ventilation.

The study points to early mobilization of patients as a beneficial strategy that is supported by suggestive (Class III) evidence. This approach significantly shortens the length of stay in the ICU and reduces the duration of mechanical ventilation in contributing to better outcomes for critically ill patients. However, this study also underscores that none of the preventive interventions demonstrated robust evidence for reducing mortality. This emphasizes the complexity of VAP management and the need for multifaceted strategies to prevent the condition and also to improve the overall patient survival.

The beneficial results of this study suggests that incorporating SDD, NIV and early mobilization into the ventilator care bundle could revolutionize the efforts of VAP prevention. These strategies enhance the patient care by reducing the burden of VAP in critical care settings and ultimately improving the prognosis of critically ill patients.

Reference:

Zhu, D., Zhao, Q., Guo, S., Bai, L., Yang, S., Zhao, Y., Xu, Y., & Zhou, X. (2024). Efficacy of preventive interventions against ventilator-associated pneumonia in critically ill patients: an umbrella review of meta-analyses. In Journal of Hospital Infection (Vol. 145, pp. 174–186). Elsevier BV. https://doi.org/10.1016/j.jhin.2023.12.017