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.