Pharmacotherapy interventions in ventilator care bundles for preventing VAP in adults: A literature review

Neilsen Gazo, Cherie Chu

Abstract

Care bundles have been introduced into practice to prevent ventilator-associated pneumonia (VAP) in critically ill adults. The Institute for Healthcare Improvement (IHI) proposed a worldwide implementation of the “IHI ventilator bundle” consisting of interventions to reduce the rate of VAP. Updates to these clinical practice bundles occur based on new evidence yet change within institutions is lagging. This review aims to discuss the latest updates in clinical evidence on the pharmacotherapy included in these bundles to aid institutional quality improvement measures. 

The 2022 Society for Healthcare Epidemiology (SHEA) practice recommendations for preventing VAP were used to identify key pharmacotherapy interventions that are commonly incorporated into hospital care bundles. Three interventions were focused on for this review: (1) Multimodal sedation and analgesia strategies; (2) Oral care with chlorhexidine; and (3) Stress ulcer prophylaxis. A comprehensive literature search was conducted utilizing PubMed, focusing on MeSH terms involving the interventions identified for further review. Literature published from August 2021 to September 2024 was focused on for this project. Findings from these studies were reviewed, summarized, and compared alongside the corresponding 2022 SHEA/IDSA/APIC update recommendations to either reinforce or challenge current VAP bundle practices.

This literature review identified a correlation with the pharmacotherapy interventions recommended in the 2022 SHEA/IDSA/APIC update on current VAP bundle practices. The findings support the preferential use of non-benzodiazepine sedatives associated with better clinical outcomes. Additionally, chlorhexidine for oral care with toothbrushing is not recommended due to a lack of strong evidence supporting its effectiveness in reducing VAP rates. Conflicting evidence regarding stress-ulcer prophylaxis remains, warranting the need for further high-quality studies to draw definitive conclusions. Overall, healthcare facilities should ultimately continue to prioritize quality improvement and stay informed on the latest recommendations to effectively prevent VAP.

Keywords: Ventilator associated pneumonia, ventilator bundle, sedation, stress ulcer prophylaxis

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