Manejo de la vía aérea para prevenir la neumonía asociada a la ventilación mecánica

Most proven effective measures are: use of orotracheal intubation rather than nasotracheal; maintenance of an optimal pressure in the pilot balloon of the endotracheal tube; avoiding unnecessary delay as assurance that the tube is removed as quickly as possible; avoiding reintubation whenever possible; replacing manifolds not routinely, but only when they are visibly contaminated or malfunctioning; sterilizing or disinfecting re-usable equipment and respiratory devices between patients; not routinely sterilizing or disinfecting the internal workings of the respiratorand anesthesia machine; washing hands and gloves when making contact with secretions and respiratory equipment. Measures of no proven effectiveness are: use of lighted endotracheal tubes for continuous subglottal suctioning of secretions; use of non-invasive mechanical ventilation to reduce the need for and duration of endotracheal intubation; use of heat moisture exchangers or hot water humidifiers; use of closed multi-use systems, or open single-use systems for aspiration of respiratory secretions.