Multiple additional risk factors have been shown
to increase the rates of VAP. These are easily divided
into non-modifiable and modifiable categories. Nonmodifiable
risk factors include male gender, increased
age (over 60 yr), history of chronic obstructive
pulmonary disease, presence of a tracheostomy or
cranial trauma, recent neurologic surgery, acute
respiratory distress syndrome, multiorgan system
failure, and coma. Potentially modifiable risk factors
include supine positioning, gastric overdistension,
colonization of ventilator circuits, low pressure in the
ETT cuff and repeated patient transfers6,