Ventilator associated pneumonia

Ventilator-associated pneumonia (VAP) is a severe and prevalent infection of the respiratory tract that can affect patients who are intubated with endotracheal tubes, even after a short period of mechanical ventilation. VAP is notably critical because it represents one of the most common infections acquired in intensive care units, impacting up to 25% of all ventilated patients. (1-3)

Intubation with an endotracheal tube significantly heightens the risk of developing VAP by facilitating the entry of bacteria into the lower respiratory tract. This access provides a direct pathway for pathogens to invade and colonize the lungs, bypassing the body’s normal airway defenses. Once established, these pathogens can cause a serious infection that complicates a patient’s recovery, extends hospital stays, and increases healthcare costs.


Main causes of VAP

1. Intubation
During the intubation itself, there is a risk of microaspiration.

2. Impaired clearance of secretions
Intubation reduces natural defense mechanisms such as the cough reflex, which otherwise protects the lungs from secretions from the upper respiratory tract.

3. Development of a biofilm
Microbial adhesion on the inside and outside of the tube results in biofilm formation. The tube attracts bacteria and other microbes. Microbial adhesion on the tube resulting in biofilm formation contributes to infections. The bacteria might come from the patient herself or external sources, such as personnel, other patients, or medical devices. Bacteria forming biofilm are more resistant to the patient’s immune system and antibiotics.

4. Subglottic secretions
Secretions that accumulate above the cuff represent an ideal growth medium for microbes. The contaminated secretions might pass down the sides of the cuff into the lower respiratory tract.

Early/late onset VAP

Ventilator-associated pneumonia is usually divided into early and late-onset infections:

  • Early onset VAP: Onset within four days after hospitalization. Often caused by community-acquired bacteria such as pneumokocker, H. influenzae, S. aureus, and antibiotic-sensitive gram-negative bacteria.
  • Late-onset VAP: Onset after ≥ 5 days of hospitalization. Often caused by more resistant bacteria such as P.eruginosa, Acinetobacter and Enterobacter.

Preventing VAP

Preventing Ventilator-Associated Pneumonia (VAP) is crucial due to its significant impact on patient health and healthcare resources. VAP not only increases morbidity and mortality but also contributes to the suffering of patients. This serious respiratory infection complicates the course of treatment for intubated patients, leading to an extended duration of both ICU and hospital stays. Specifically, patients who develop VAP spend an average of 6.1 more days in the ICU and an additional 11.5 days in the hospital compared to those without VAP. (4)

The financial implications of VAP are also substantial, with the attributable cost per VAP case estimated at about 25,000 Euros. (5) This figure encompasses direct costs such as extended use of antibiotics, additional diagnostic tests, increased use of healthcare resources, and indirect costs including lost productivity and increased workload for healthcare staff.

Prevention strategies for VAP are therefore not only a clinical priority but also an economic necessity. These strategies include rigorous adherence to infection control protocols such as hand hygiene and proper sterilization of equipment, the use of oral care regimens to reduce bacterial colonization, elevation of the head of the bed to prevent aspiration, and the implementation of ventilator care bundles. Additionally, promoting a ventilator weaning protocol to minimize the duration of mechanical ventilation can significantly reduce the risk of developing VAP.

By implementing these targeted strategies, healthcare facilities can greatly diminish the incidence of VAP, leading to improved patient outcomes, reduced duration of hospital stays, and considerable cost savings. Effective VAP prevention requires a multidisciplinary approach involving physicians, nurses, respiratory therapists, and infection control specialists, all committed to adhering to best practices in patient care.

New study shows a 53% reduction of VAP with Bactiguard’s endotracheal tube

A Belgian study published in the renowned journal Annals of Intensive Care, shows that the risk of VAP in intensive care patients is reduced by 53% when using Bactiguard’s endotracheal tubes with subglottic secretion drainage (BIP ETT Evac).Read more about the study.

Read more about Bactiguard’s infection prevention endotracheal tube BIP ETT >>>

The unique Bactiguard technology reduces microbial adhesion on the endotracheal tube surface

The Bactiguard technology (Bactiguard Infection Protection) is based on a very thin noble metal alloy coating, firmly attached to the endotracheal tube surface. When in contact with fluids the noble metals create a galvanic effect, which reduces microbial adhesion. This means that less bacteria adhere to Bactiguard’s endotracheal tube, which reduces the risk of biofilm formation leading to infection.

1. Ibrahim EH et al. Chest. 001;120(2):555–561.
2. Craven DE et al. Infect. 1996;11(1):32–53.
3. Rello J et al. Chest. 2002;122(6):2115–2121.
4. Rello J, Ollendorf DA, Oster G, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 2002;122:2115–21.
5. Hyllienmark P. Hospital-acquired pneumonia in intensive care patients [avhandling]. Stockholm: Karolinska institutet; 2013.
6. Damas, P., Legrain, C., Lambermont, B. et al. Prevention of ventilator-associated pneumonia by noble metal coating of endotracheal tubes: a multi-center, randomized, double-blind study. Ann. Intensive Care 12, 1 (2022).