Strategies to prevent ventilator-associated pneumonia in critically ill mechanically ventilated patients: a SIAARTI consensus statement

Background: Ventilator-associated pneumonia (VAP) remains a major complication in mechanically ventilated critically ill patients. Although several preventive strategies have been proposed and incorporated into international guidelines, emerging evidence and evolving epidemiology warrant updated statements. The Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) developed an expert consensus statement to provide pragmatic guidance for VAP prevention. Methods: This consensus statement was developed in accordance with SIAARTI methodology for consensus-based documents. A multidisciplinary panel of 10 experts was appointed and identified key items through a modified Delphi process. Consensus was defined as ≥ 75% agreement within the same Likert scale range. A structured literature search was conducted. Statements and supporting rationales were drafted by multidisciplinary subgroups and subjected to blinded voting. External peer review was performed prior to final approval. Results: Of ten proposed items, four achieved consensus in agreement and were included in the final document. Individual statements address: (1) subglottic secretion drainage, (2) endotracheal cuff pressure control, (3) chlorhexidine for oral hygiene, and (4) selective digestive decontamination (SDD). Subglottic secretions drainage and appropriate cuff pressure control are supported as preventive measures, while routine chlorhexidine use is not recommended outside selected cardiac surgery populations, and SDD was demonstrated effective to reduce VAP and mortality in low multidrug-resistant (MDR) settings. Conclusions: This consensus statement provides updated, pragmatic guidance for VAP prevention. Implementation should consider local epidemiology, particularly MDR prevalence, and patient-specific risk profiles.