As highlighted in a recent pearl, ventilator-associated pneumonia (VAP) is the second most common nosocomial infection in the US and is associated with increases in ICU length of stay and mortality.
With increasing ED lengths of stay for many critically ill patients receiving mechanical ventilation, measures to prevent VAP should be initiated in the ED.
In addition to elevating the head of the bed to 30-45 degrees, another low cost intervention is the measurement of endotracheal tube cuff pressures.
Cuff pressures below 20 cm H2Oincrease the risk of VAP.
Measure cuff pressure within 4 hours of inflation and maintain between 20-30 cm H2O.
References
Grap MJ, et al. Ventilator-associated pneumonia: The potential critical role of emergency medicine in prevention. JEM 2012; 42:353-362.
