Measures to prevent ventilator-associated pneumonia
should be in place, including elevation of the head
of the bed, mouth care, and gastrointestinal prophylaxis.
Lung infections are treated with appropriate antibiotics.
Cuff pressure should be optimized to ensure that no
leakage of secretions around the cuff occurs. However,
the cuff should not be overinflated, because overinflation
can contribute to the development of tracheomalacia
and tracheal stenosis.38,43
The tracheostomy site should be inspected for indications
of inflammation and infection, such as increased
redness, swelling, odor, and drainage. Stomal infections
can be stubborn, but they can be effectively treated locally
with silver-infused products such as primary wound
dressings made from sodium carboxymethylcell ulose
containing 1.2% silver in an ionic form (Aquacel Ag),
silver-impregnated nylon dressings (Silverlon), or colloidal
silver gel