Ventilator-associated Pneumonia (VAP)
On our critical care units (cardiovascular ICU and regular ICU), we are focusing on VAP prevention by examining our VAP protocols. We have recently experienced a rise in the number of VAPs occurring on both Unit A CVICU and Unit B ICU. Our current protocol used on both ICU units for care of the intubated patient includes elevating the head of bed approximately, providing oral care every shift and turning the patient every two hours. When appropriate, and ordered by the physician, we also initiate a ‘sedation vacation’, where the patient is brought out of sedation for 30 minutes then re-sedated. This is done following an algorithm and is validated with the consent of a physician prior to initiation. Consent is usually obtained when the physician is on the unit and is good for 24 hours. These steps have worked wonderfully up until the past year when the number of VAPS on the Intensive Care Units steadily rose.We thought we were following best practices but now we are not sure. Our goal is zero VAPS, but we are not sure that this is even possible. Can you help us figure out what our problem is (or problems are) and how we can fix them?
You should include the following:
- What is your PICO question? Post completed PICO template and question
- Summarize your search strategy
- Indicate the tool you selected to use for critical appraisal and rationale for selection (Note: You will likely identify and appraise several items to determine the “best available evidence” to include in final report. In this discussion post, you are required to post only one appraised item)
- Post completed appraisal/checklist; this should include appraisal criteria and how you applied the appraisal process to your selected resource
- Include any questions you have and/or challenges encountered
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