Bundles for the prevention of ventilator-associated pneumonia

Abstract

Objective: To identify the components of Ventilator-Associated Pneumonia (VAP) prevention bundles, analyzing their essentiality, operational feasibility, and the role of governance strategies in sustaining multiprofessional practice in Intensive Care Units (ICUs). Methods: An integrative review was conducted using national and international databases (PubMed/MEDLINE, Embase, Cochrane Library, Web of Science, Scopus, CINAHL, LILACS, and SciELO), applying the PICO strategy and the PRISMA flowchart for study selection. The time frame from March 2021 to March 2026 resulted in the inclusion of 12 high-impact studies, which were analyzed through thematic synthesis in two axes: essential strategies and advanced interventions. Results: Full adherence (all-or-nothing) to the essential core  oral hygiene with mechanical toothbrushing, daily sedation interruption, spontaneous breathing trials, and early mobilization  showed the strongest evidence for reducing VAP and ventilator-associated events. Complementary technologies, such as subglottic drainage and cuff pressure control, contributed as process stabilizers, while digital governance emerged as a determining factor for the sustainability of multiprofessional adherence. Final considerations: Effective prevention of VAP depends on the consolidation of an essential core of care, combined with objective surveillance and the strengthening of a safety culture.