Prevention of Ventilator-Associated

Pneumonia

As in all nosocomial infections, prevention is the most

efficacious approach. Excessive use of gastric pH–altering

medications for stress ulcer prophylaxis increases gastric

pH and the risk for VAP.182 The use of sucralfate, an

agent that does not increase gastric pH, may be preferable

to H2-receptor antagonists or proton pump inhibitors.

Positioning of the head of the bed at 30 degreesis the most cost-effective intervention to prevent VAP. With this intervention, Drakulovic and coworkers found

a decreased rate of VAP with no adverse effects.183 This

position results in decreased gastroesophageal reflux and

is easily implemented and monitored.