By definition, ventilator-associated pneumonia (VAP) is an airways infection that must have developed more than 48 hours after the patient was intubated.  Preventing pneumonia of any variety seems at first blush to be a laudable goal.  However, there are some reasons to be particularly concerned about the impact of pneumonia associated with ventilator use.

VAP is the leading cause of death amongst hospital-acquired infections, exceeding the rate of death due to central line infections, severe sepsis, and respiratory tract infections in the non-intubated patient.  Perhaps the most concerning aspect of VAP is the high associated mortality.  Hospital mortality of ventilated patients who develop VAP is 46 percent compared to 32 percent for ventilated patients who do not develop VAP. [1] 

In addition, VAP prolongs time spent on the ventilator, length of ICU stay, and length of hospital stay after discharge from the ICU. [2]  Strikingly, VAP adds an estimated cost of $40,000 to a typical hospital admission. [3]

Reducing mortality due to ventilator-associated pneumonia requires an organized process that guarantees early recognition of pneumonia and consistent application of the best evidence-based practices.  

The Ventilator Bundle is a series of interventions related to ventilator care that, when implemented together, will achieve significantly better outcomes than when implemented individually.

The key components of the Ventilator Bundle are:

• Elevation of the Head of the Bed
• Daily "Sedation Vacations" and Assessment of Readiness to Extubate
• Peptic Ulcer Disease Prophylaxis
• Deep Venous Thrombosis Prophylaxis 

References:

1. Ibrahim EH, Tracy L, Hill C, et al. The occurrence of ventilator-associated pneumonia in a community hospital: Risk factors and clinical outcomes. Chest. 2001 Aug;120(2):555-561. 
2. Rello J, Ollendorf DA, Oster G, et al. VAP Outcomes Scientific Advisory Group.  Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest. 2002 Dec;122(6):2115-2121. 
3. Tablan OC, Anderson LJ, Besser R, et al. CDC Healthcare Infection Control Practices Advisory Committee. Guidelines for preventing health care-associated pneumonia, 2003: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep. 2004 Mar 26;53(RR-3):1-36.