Grap et al. also showed that the ri

Grap et al. also showed that the risk of VAP is higher among the patients with bed head elevation of less than 30°. The present study showed that an increase in bed head elevation up to 45° for seven straight days could reduce the risk of VAP in clinically critical patients. Chao et al. showed that oral suctioning before position change, in long term, could reduce the incidence of VAP by 32%.[21] A reduction in the incidence of VAP resulted from airway care protocols such as regulating the cuff pressure to about 25 cm H2O, maintaining the bed head elevation up to 45°, and oral and subgluteal suctioning before each position change, which seems to be associated with aspiration of patients’ secretions.[14,23,24] Therefore, nursing staff can reduce the incidence of VAP through administration of such an intervention in addition to other interventions, thereby decreasing the risk of patients’ aspiration. There were two limitations in the present study: the absence of an identical tracheal tube suctioning method and not administering an identical respiratory physiotherapy in the patients that could have affected the incidence of VAP. These two limitations might have affected the results obtained in our study.