| Recommendation | Rationale | Intervention | Quality of evidence |
| Basic practices | Good evidence that the intervention decreases the average duration of mechanical ventilation, length of stay, mortality, and/or costs; benefits likely outweigh risks | Use noninvasive positive pressure ventilation in selected populations | High |
| Manage patients without sedation whenever possible | Moderate | ||
| Interrupt sedation daily | High | ||
| Assess readiness to extubate daily | High | ||
| Perform spontaneous breathing trials with sedatives turned off | High | ||
| Facilitate early mobility | Moderate | ||
| Utilize endotracheal tubes with subglottic secretion drainage ports for patients expected to require greater than 48 or 72 hours of mechanical ventilation | Moderate | ||
| Change the ventilator circuit only if visibly soiled or malfunctioning | High | ||
| Elevate the head of the bed to 30 to 45° | Low* | ||
| Special approaches | Good evidence that the intervention improves outcomes but insufficient data available on possible risks | Selective oral or digestive decontamination | High¶ |
| May lower VAP rates but insufficient data to determine impact on duration of mechanical ventilation, length of stay, or mortality | Regular oral care with chlorhexidine | Moderate | |
| Prophylactic probiotics | Moderate | ||
| Ultrathin polyurethane endotracheal tube cuffs | Low | ||
| Automated control of endotracheal tube cuff pressure | Low | ||
| Saline instillation before tracheal suctioning | Low | ||
| Mechanical tooth brushing | Low | ||
| Generally not recommended | Lowers VAP rates but ample data suggest no impact on duration of mechanical ventilation, length of stay, or mortality | Silver-coated endotracheal tubes | Moderate |
| Kinetic beds | Moderate | ||
| Prone positioning | Moderate | ||
| No impact on VAP rates, average duration of mechanical ventilation, length of stay, or mortalityΔ | Stress ulcer prophylaxis | Moderate | |
| Early tracheotomy | High | ||
| Monitoring residual gastric volumes | Moderate | ||
| Early parenteral nutrition | Moderate | ||
| No recommendation | No impact on VAP rates or other patient outcomes, unclear impact on costs | Closed/in-line endotracheal suctioning | Moderate |
