Essential aspects of the prevention of ventilator-associated pneumonia: A State-of-the-Art Review.

Authors

Evdoxia Tsigou, Georgios Papathanakos, Elena Conoscenti, Marios Karvouniaris, Efstratios Vamvakas, Christina Bampou, Nikolaos Dalavouras, Maria Markou, Maria Panagiotouni, Elisabeth Paramythiotou, Vipin Varghese, Stijn Blot, Despoina Koulenti

Published in

Intensive & critical care nursing. Pages 104598. Oct 07, 2026. Epub Oct 07, 2026.

Abstract

Ventilator-associated pneumonia (VAP) is a major cause of morbidity and mortality in the ICU and is associated with high antibiotic consumption and increased healthcare resource utilization.
This review provides an updated overview of current strategies for VAP prevention.
A narrative review of the literature was conducted, including randomized controlled trials, systematic reviews, meta-analyses, and recent international guidelines and position papers on VAP prevention.
Successful VAP prevention depends on both effective implementation strategies and evidence-based clinical interventions. Current preventive measures target the main mechanisms involved in VAP pathogenesis, including prolonged mechanical ventilation, microaspiration, endotracheal tube biofilm formation, and colonization of the aerodigestive tract. Routine preventive measures with the strongest supporting evidence include minimizing the duration of mechanical ventilation and sedation, avoiding unnecessary intubation and re-intubation, semi-recumbent positioning, oral care with toothbrushing rather than chlorhexidine, early enteral nutrition, and the use of structured prevention bundles. Additional interventions, such as subglottic secretion drainage, selective digestive or oropharyngeal decontamination, inhaled antibiotics, early tracheostomy, and post-pyloric feeding, may be beneficial in appropriately selected patients or specific clinical settings. In contrast, some interventions have inconsistent evidence of clinical benefit and are not recommended for routine use.
Preventing VAP requires a multimodal approach that integrates organizational support with evidence-based preventive measures. As new evidence continues to emerge, prevention bundles should be regularly updated to optimize effectiveness while avoiding interventions that are ineffective or potentially harmful.
Implementation of VAP prevention strategies should focus on interventions supported by the best available evidence, while tailoring selected strategies to local epidemiology, available resources, and individual patient characteristics. Consistent adherence to multidisciplinary prevention bundles remains fundamental for reducing the burden of VAP.

PMID:
42844031
Bibliographic data and abstract were imported from PubMed on 08 Oct 2026.

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