Ventilator-associated pneumonia: the role of ventilator management strategies.
Ventilator management strategies can affect the risk for ventilator-associated pneumonia in 3 ways: the development of ventilator-induced lung injury; the need for potentially harmful tradeoffs in providing lung-protective ventilatory strategies; and the prolongation of the duration of mechanical ventilation from iatrogenic factors. Strategies to reduce ventilator-induced lung injury include a smaller tidal volume and careful attention to reducing the maximum pressures in the lung. These lung-protective strategies, however, may require tradeoffs with factors that may in themselves produce risks for ventilator-associated pneumonia. Specifically, hypercapnia, discomfort requiring sedation, and atelectasis may all be potential problems with a lung-protective strategy. However, the weight of evidence suggests that beneficial outcomes from lung-protective strategies outweigh any potential harm from these tradeoffs. Finally, properly performed weaning protocols based on clinical evidence should reduce any iatrogenic delays in ventilator weaning and thereby minimize prolongation of unneeded mechanical ventilatory support.
MacIntyre
Neil R
NR
Respiratory Care Services, PO Box 3911, Duke University Medical Center, Durham, NC 27710, USA. neil.macintyre@duke.edu
D006801:Humans; D006993:Hypnotics and Sedatives; D011014:Pneumonia / Q000517:prevention & control* / Q000628:therapy*; D011175:Positive-Pressure Respiration; D001261:Pulmonary Atelectasis / Q000503:physiopathology; D012307:Risk Factors; D014481:United States; D012122:Ventilators, Mechanical / Q000009:adverse effects*
D006993:Hypnotics and Sedatives