title: Bundles to prevent ventilator-associated pneumonia: how valuable are they?
abstract: OBJECTIVE
  To review the value of care bundles to prevent ventilator-associated pneumonia (VAP).
  
  
  RESULTS
  The Ventilator Bundle contains four components, elevation of the head of the bed to 30-45 degrees, daily 'sedation vacation' and daily assessment of readiness to extubate, peptic ulcer disease prophylaxis, and deep venous thrombosis prophylaxis, aimed to improve outcome in mechanically ventilated patients, but not all are associated with VAP prevention. Daily spontaneous awakening and breathing trials are associated with early liberation from mechanical ventilation and VAP reduction. Although a small prospective, randomized clinical study documented that the semirecumbent position was associated with a significant reduction in VAP, more recent studies have documented that the semirecumbent position is difficult to maintain in mechanically ventilated patients and may not impact VAP reduction. Prophylaxis for peptic ulcer disease and deep venous thrombosis do not directly impact VAP reduction. Other methods to reduce VAP, such as oral care and hygiene, chlorhexidine in the posterior pharynx, and specialized endotracheal tubes (continuous aspiration of subglottic secretions, silver-coated), should be considered for inclusion in a revised Ventilator Bundle more specifically aimed at VAP prevention.
  
  
  CONCLUSIONS
  The Ventilator Bundle is an effective method to reduce VAP rates in ICUs. The ventilator bundle should be modified and expanded to include specific processes of care that have been definitively demonstrated to be effective in VAP reduction or a specific VAP bundle created to focus on VAP prevention.
authors.affiliation: Department of Surgery, University of Michigan Health System, University Hospital, 1500 East Medical Drive, Ann Arbor, MI 48109-0033, USA.
authors.forename: Charity
authors.initials: C
authors.lastname: Wip
authors.forename: Lena
authors.initials: L
authors.lastname: Napolitano
mesh_terms: D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D006801:Humans; D010437:Peptic Ulcer / Q000517:prevention & control; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D012121:Respiration, Artificial / Q000379:methods*; D053120:Respiratory Aspiration; D020246:Venous Thrombosis / Q000517:prevention & control
chemical_list: D000891:Anti-Infective Agents, Local