A potential bundle for preventing ventilator-associated pneumonia in the emergency department: A narrative review

Ventilator-associated pneumonia substantially increases mortality and imposes a heavy burden on healthcare resources. Patients undergoing endotracheal intubation and mechanical ventilation in emergency departments face a particularly high risk of ventilator-associated pneumonia. Compared with healthcare providers in intensive care units, those in emergency departments often lack sufficient awareness of timely and systematic ventilator-associated pneumonia prevention strategies, and existing intensive care unit-based care bundles are rarely tailored to emergency department-specific constraints. This gap leads to suboptimal implementation of ventilator-associated pneumonia preventive measures and increases the risk of ventilator-associated pneumonia. In this narrative review, we synthesize the current evidence on ventilator-associated pneumonia prevention and assess the feasibility of care bundles in resource-constrained emergency department settings. We propose the use of position, hand hygiene, airway, sedation, and equipment-a structured, multicomponent ventilator-associated pneumonia prevention strategy-in emergency departments with limited resources, supported by enabling strategies such as electronic checklists, multidisciplinary collaboration, and training to ensure adherence. Moving forward, efforts should focus on establishing consensus on emergency department-specific ventilator-associated pneumonia prevention protocols and optimizing nursing resource allocation to support implementation.