Head of bed elevation and ventilator-associated pneumonia.

Ventilator-associated pneumonia (VAP) is a common hospital-acquired infection.1 Criteria for the diagnosis of VAP have been published2 and widely adopted by hospital infection control surveillance programs. A number of clinical factors can make the diagnosis of VAP difficult in selected patient populations and bring the applicability of these diagnostic criteria into question.1,3,4 These difficulties in determining how frequently VAP occurs, however, have not prevented the disease from being closely scrutinized. The impact of VAP on patient mortality may be difficult to estimate, but the development of VAP appears to increase the length of hospitalization and increase healthcare costs.1,5,6 The consideration of VAP as a “preventable” infection by some healthcare regulatory agencies, and the impact of this designation on reimbursement have heightened interest in improving accuracy in the diagnosis and reporting of VAP.1–4 These initiatives have also stimulated efforts to prevent or minimize the frequency of VAP, and a variety of “ventilator bundles” have been developed.7,8 Guidelines for hand hygiene, oral care, ventilator circuit tube changes, sedation, and spontaneous breathing trials are included in many such bundles. Elevation of the head of the bed (HOB) to minimize aspiration, particularly in patients receiving enteral nutrition, is also a common component of ICU ventilator bundles.9