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Ventilator Associated Pneumonia

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What is Ventilator-Associated Pneumonia (VAP)?

Pneumonia is defined as Ventilator-Associated Pneumonia (VAP) if an invasive respiratory device was present (even intermittently) in the 48 hours preceding the onset of infection.1,2
Patients who require invasive mechanical ventilation are at risk for ventilator-associated pneumonia (VAP).

Ventilator-Associated Pneumonia (VAP) is the most common and deadly ICU nosocomial infection.1-3

The most common cause of ventilator-associated pneumonia is microaspiration of bacteria that colonize the oropharynx and upper airways in seriously ill patients4, and it presents with clinical signs that include purulent tracheal discharge, fevers, and respiratory distress in the presence of microorganisms.5

The clinical and economic impact of Ventilator-Associated Pneumonia

Up to 51% of direct mortality1,3,6-8

Up to 16 extra days on mechanical ventilation9,10

Up to 20 extra days in the intensive care unit9-13

Up to €42.300 extra cost per VAP episode11,13-15

Our integrated solutions contribute to Ventilator-Associated Pneumonia reduction.
 

ICU Solutions for VAP:

Our integrated solutions aim to:
 

  • Enhance preventive bundle compliance
  • Improve patient experience and outcomes
  • Assist you with daily patient management
  • Improve the quality of care

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Product technologies for Ventilator Associated Pneumonia prevention

Shiley™

Flexible adult evac tracheostomy tubes with TaperGuard™ cuff technology
 

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Shiley™

Evac oral endotracheal tube with TaperGuard™cuff technology
 

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Hersill VACUSILL® 3

Subglottic automatic suction system 
 

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Puritan Bennett™

Cuff pressure manager
 

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Shiley™ tracheostomy tube for VAP prevention

Continous pressure control in tapered cuff endotracheal tube (ETT) with continous automatic subglottic secretion suction can reduce the total incidence of Ventilator-Associated Pneumonia (VAP) up to 50%, as well as increase the time to Ventilator-Associated Pneumonia (VAP) in mechanically ventilated ICU patients.16 Subglottic secretion drainage reduces the incidence of VAP in critically ill patiens requiring ongoing mechanical ventilation via tracheostomy.18
Flexible adult evac tracheostomy tubes with TaberGuard™ cuff technology

  • Integrated evac lumen enables removal of secretions from subglottic spaces
  • Designed with a slightly larger outer diameter to support the evac lumen for secretion removal
  • Available in single cannula, reusable inner cannula and disposable inner cannula configurations

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Evac oral endotracheal tube with TaperGuard™ cuff technology

Shiley™ evac technology
Subglottic secretion drainage (SSD) helps remove oral and/or gastric secretions from above the endotracheal tube cuff before they can be aspirated.22

TaperGuard™ cuff technology 
The tapered-shape cuff allows for uniform pressure distribution to maintain an adequate seal thereby reducing the risk of microaspiration.21

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Subglottic secretion drainage (SSD) was found to be an effective measure to prevent VAP with (44% risk reduction).17

Hersill VACUSILL® 3 for VAP
Subglottic automatic suction system

Traditional versus automatic secretions drainage: 

Direct wall suction

  • Cannot be regulated - Risk of high pressure (4x > recommended) or too low to aspirate
  • Risk of cross-infection (37% of regulators colonized)19
  • No filter to prevent backlog

Syringe suction

  • Pressure 4-5x higher (-580 to -720 mmHg) than recommended (<-150mmHg)
  • Limited volume of secretions collected19

Automatic pump:

  • Optimized to recommended pressure 
  • Optimal On/Off cycle to maximize secretion collection while minimizing injury the tracheal mucosa19
  • Collect up to 10x more secretions daily than other modalities19 
  • Significantly reduce cross-contamination through use of an integrated, self-contained, disposable canister and filter

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When technology, driven by evidence-based research, is fully engaged, it can be used to design andengineer the breakthrough devices that will improve, optimize and change the way we administer proven therapies.19

Puritan Bennett™ for VAP

Cuff pressure manager

Offers a simple solution to a serious safety issue by continuously measuring and automatically maintaining cuff pressure of the ventilated patients:

  • Reduces manual work of measuring and adjusting cuff pressure with a manometer and syringe20,23,24
  • Provides uninterrupted monitoring and management 
  • Improves adherence to established cuff pressure protocols25

It's designed to support cuffed endotracheal tubes or cuffed tracheostomy tubes for adult and pediatric patients in the following sizes:

Cuffed endotracheal tubes:
Sizes 3 - 10 (inner diameter)

Cuffed tracheostomy tubes:
Sizes 2.5 - 10 (inner diameter of outer cannula)

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Continuous control of cuff was associated with significantly reduced incidence of VAP (53% risk reduction)20

With our Ventilator-Associated Pneumonia (VAP) integrated solutions, we aim to:

Contribute

to prevent patient complications and alleviate relatives' emotional distress.
 

Facilitate

the work of the healthcare professionals and improve the quality of the care provided.
 

Cooperate

to reduce VAP incidence and hospital's direct costs.

Improve patient experience and outcomes.

Interested in a free demo of our Ventilator-Associated Pneumonia (VAP) integrated solutions?

Book now

References
  1. de Miguel-Díez J, López-de-Andrés A, Hernández-Barrera V, Jiménez-Trujillo I, Méndez-Bailón M, Miguel-Yanes JM, Del Rio-Lopez B, Jiménez-García R. Decreasing incidence and mortality among hospitalized patients suffering a ventilator-associated pneumonia: Analysis of the Spanish national hospital discharge database from 2010 to 2014. Medicine (Baltimore). 2017 Jul;96(30):e7625. doi: 10.1097/MD.0000000000007625.
  2. European Centre for Disease Prevention and Control. Healthcare-associated infections acquired in intensive care units. In: ECDC. Annual epidemiological report for 2016. Stockholm: ECDC; 2018.
  3. Chouhdari A, Shokouhi S, Bashar FR, Vahedian Azimi A, Shojaei SP, Fathi M, Goharani R, Sahraei Z, Hajiesmaeili M. Is a Low Incidence Rate of Ventilation Associated Pneumonia Associated with Lower Mortality? a Descriptive Longitudinal Study in Iran.
  4. ETHI.SANJAY. Ventilator-Associated Pneumonia. Merck Manuals Professional Edition. Published 2018. https://www.merckmanuals.com/professional/pulmonary-disorders/pneumonia/ventilator-associated-pneumonia
  5. Kohbodi GA, Rajasurya V, Noor A. Ventilator-associated Pneumonia. PubMed. Published September 4, 2023. https://www.ncbi.nlm.nih.gov/books/NBK507711/
  6. Xie J, Yang Y, Huang Y, Kang Y, Xu Y, Ma X, Wang X, Liu J, Wu D, Tang Y, Qin B, Guan X, Li J, Yu K, Liu D, Yan J, Qiu H. The Current Epidemiological Landscape of Ventilator-associated Pneumonia in the Intensive Care Unit: A Multicenter Prospective Observational Study in China. Clin Infect Dis. 2018 Nov 13;67(suppl_2):S153-S161. doi: 10.1093/cid/ciy692.
  7. Feng DY, Zhou YQ, Zhou M, Zou XL, Wang YH, Zhang TT. Risk Factors for Mortality Due to Ventilator-Associated Pneumonia in a Chinese Hospital: A Retrospective Study. Med Sci Monit. 2019 Oct 12;25:7660-7665. doi: 10.12659/MSM.916356.
  8. Blot S, Koulenti D, Dimopoulos G, Martin C, Komnos A., Krueger WA, Spina G, Armaganidis A, Rello J. Prevalence, Risk Factors, and Mortality for Ventilator-Associated Pneumonia in Middle-Aged, Old, and Very Old Critically Ill Patients*. Critical Care Medicine. 2014. 42(3), 601–609. doi:10.1097/01.ccm.0000435665.07446.50
  9. Nik Nurfazleen MZ, Mohamad Hasyizan H, Laila Ab M, Zeti Norfidiyati S, Kamaruddin I, Mahamarowi O, Mohd Zulfakar M. Clinical characteristics and factors associated with diagnoses of ventilator and non-ventilator associated pneumonia in Intensive care unit. Med J Malaysia. 2021 May;76(3):353-359.
  10. Steen J, Vansteelandt S, De Bus L, Depuydt P, Gadeyne B, Benoit DD, Decruyenaere J. Attributable Mortality of Ventilator-associated Pneumonia. Replicating Findings, Revisiting Methods. Ann Am ThorI30:S30ac Soc. 2021 May;18(5):830-837. doi: 10.1513/AnnalsATS.202004-385OC.
  11. Ory J, Mourgues C, Raybaud E, Chabanne R, Jourdy JC, Belard F, Guérin R, Cosserant B, Faure JS, Calvet L, Pereira B, Guelon D, Traore O, Gerbaud L. Cost assessment of a new oral care program in the intensive care unit to prevent ventilator-associated pneumonia. Clin Oral Investig. 2018 Jun;22(5):1945-1951. doi: 10.1007/s00784-017-2289-6
  12. Pouly O, Lecailtel S, Six S, Préau S, Wallet F, Nseir S, Rouzé A. Accuracy of ventilator-associated events for the diagnosis of ventilator-associated lower respiratory tract infections. Ann Intensive Care. 2020 Jan 13;10(1):6. doi: 10.1186/s13613-020-0624-6.
  13. Duszynska W, Idziak M, Smardz K, Burkot A, Grotowska M, Rojek S. Frequency, Etiology, Mortality, Cost, and Prevention of Respiratory Tract Infections—Prospective, One Center Study. Journal of Clinical Medicine. 2022; 11(13):3764. https://doi.org/10.3390/jcm11133764
  14. Rodrigues J, Sousa P. Economic and Clinical Impact of Ventilator-Associated Pneumonia in Intensive Care Units of a University Hospital Center. In: Cotrim, T., Serranheira, F., Sousa, P., Hignett, S., Albolino, S., Tartaglia, R. (eds) Health and Social Care Systems of the Future: Demographic Changes, Digital Age and Human Factors. HEPS 2019. Advances in Intelligent Systems and Computing, vol 1012. Springer, Cham. https://doi.org/10.1007/978-3-030-24067-7_16
  15. Luckraz H, Manga N, Senanayake EL, Abdelaziz M, Gopal S, Charman SC, Giri R, Oppong R, Andronis L. Cost of treating ventilator-associated pneumonia post cardiac surgery in the National Health Service: Results from a propensity-matched cohort study. J Intensive Care Soc. 2018 May;19(2):94-100. doi: 10.1177/1751143717740804.
  16. Tomaszek, L.; Pawlik, J.; Mazurek, H.; M ˛edrzycka-D ˛abrowska, W. Automatic Continuous Control of Cuff Pressure and Subglottic Secretion Suction Used Together to Prevent Pneumonia in Ventilated Patients—A Retrospective and Prospective Cohort Study. J. Clin. Med. 2021, 10, 4952. https://doi.org/ 10.3390/jcm10214952
  17. Pozuelo-Carrascosa DP, Herráiz-Adillo Á, Alvarez-Bueno C, et al. Subglottic secretion drainage for preventing ventilator-associated pneumonia: an overview of systematic reviews and an updated meta-analysis. Eur Respir Rev 2020; 29: 190107 [https://doi.org/10.1183/16000617.0107-2019].
  18. Terragni P, Urbino R, Mulas F, Pistidda L, Cossu AP, Piredda D, Faggiano C, Falco D, Magni G, Mascia L, Filippini C, Ranieri VM. Occurrence of ventilator associated pneumonia using a tracheostomy tube with subglottic secretion drainage. Minerva Anestesiol. 2020 Aug;86(8):844-852. doi: 10.23736/S0375-9393.20.13989-0.
  19. Gentile J, Fendler H. Respiratory Therapy, The Journal of Pulmonary Technique. Volume 11 Number 2. Spring 2016.
  20. Nseir et al. Ann. Intensive Care (2015) 5:43 DOI 10.1186/s13613-015-0087-3
  21. Mahmoodpoor A, Hamishehkar H, Hamidi M, Shadvar K, Sanaie S, Golzari SE, Khan ZH, Nader ND. A prospective randomized trial of tapered-cuff endotracheal tubes with intermittent subglottic suctioning in preventing ventilator-associated pneumonia in critically ill patients. J Crit Care. 2017 Apr;38:152-156. doi: 10.1016/j.jcrc.2016.11.007. Epub 2016 Nov 14. PMID: 27912161.
  22. Coelho, L.; Moniz, P.; Guerreiro, G.; Póvoa, P. Airway and Respiratory Devices in the Prevention of Ventilator-Associated Pneumonia. Medicina 2023, 59, 199. https://doi.org/10.3390/ medicina59020199
  23. Anahita Rouzé, Julien De Jonckheere, Farid Zerimech, Julien Labreuche, Erika Parmentier‑Decrucq, Benoit Voisin, Emmanuelle Jaillette, Patrice Maboudou, Malika Balduyck and Saad Nseir - Efficiency of an electronic device in controlling tracheal cuff pressure in critically ill patients: a randomized controlled crossover study
  24. Zunjia Wen, Li Wei, Junyu Chen, Ailing Xie, Mei Li and Lanzheng Bian - Is continuous better than intermittent control of tracheal cuff pressure? A meta-analysis
  25. Shai Efrati, MD, Gil Bolotin, MD, PhD, Leon Levi, MD, MHA, Menashe Zaaroor, MD, DSc, Ludmila Guralnik, MD, Natan Weksler, MD, Uriel Levinger, MD, Arie Soroksky, MD, William T. Denman, MD, PhD, and Gabriel M. Gurman - Optimization of Endotracheal Tube Cuff Pressure by Monitoring CO2 Levels in the Subglottic Space in Mechanically Ventilated Patients: A Randomized Controlled Trial

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