The prevention of ventilator-associated pneumonia (VAP) is a key part of managing critically ill patients who require invasive mechanical ventilation. Despite a reduction in exposure to mechanical ventilation, the incidence of VAP remains high, significantly impacting outcomes. In this brief review, at the light of recent meta-analyses, we examine the evolution of VAP prevention over the past few decades and attempt to predict future developments.

Care of critically ill patients involves large amounts of medication, perhaps more than any other aspect of the healthcare system. This has substantial environmental impacts. This manuscript describes how the environmental impacts of medications arise along their lifecycle, how to assess those impacts, and opportunities to reduce medication environmental impact across the critical care and caring continuum. Critical care practitioners and trainees have a long career ahead of them, and should be aware of, reflect, and act to address the planetary impact of medications.