General Measures:
1. Conduct active surveillance for ventilator associated conditions,10 including but not limited to:
2. Perform daily assessments of readiness for extubation including:
Required criteria
a. The cause of the respiratory failure has improved.
b. PaO2/FiO2 ≥150 or SpO2 ≥90 percent on FiO2 ≤ 50 percent and positive end-expiratory pressure (PEEP) ≤ 8 cmH2O
c. pH >7.25
d. Hemodynamic stability (no or low dose vasopressor medications)
e. Able to initiate a spontaneous inspiratory effort.
Additional criteria (optional criteria)
a. Hemoglobin ≥7 mg/dL
b. Core temperature ≤38 to 38.5°Centigrade
c. Mental status awake and alert or easily arousable with ability to protect airway.
Staff Education priorities
1. Epidemiology of Ventilator Associated Events
2. Infection-control procedures for prevention of VAP
3. Periodic audits of the use of guidelines with aggressive education and enforcement of procedures.