 |
|
Influence of Airway Management on Ventilator-Associated Pneumonia
Evidence From Randomized Trials
Deborah Cook, MD;
Bernard De Jonghe, MD;
Laurent Brochard, MD;
Christian Brun-Buisson, MD
JAMA. 1998;279:781-787.
Objective.— Ventilator-associated pneumonia (VAP) is a serious complication of critical illness, conferring increased morbidity and mortality. Many interventions have been studied to reduce the risk of VAP. We systematically reviewed the influence of airway management on VAP in critically ill patients.
Data Sources.— Studies were identified through searching MEDLINE and EMBASE from 1980 through July 1997 and by searching SCISEARCH, the Cochrane Library, bibliographies of primary and review articles, personal files, and contact with authors of the randomized trials.
Study Selection.— We selected randomized trials evaluating ventilator circuit and secretion management strategies on the rate of VAP.
Data Extraction.— Two investigators independently abstracted key data on design features, the population, intervention, and outcome of the studies.
Data Synthesis.— The frequency of ventilator circuit changes and the type of endotracheal suction system do not appear to influence VAP rates (3 trials, none with significant difference; range of relative risks [RRs], 0.84-0.91). However, lower VAP rates may be associated with avoidance of heated humidifiers and use of heat and moisture exchangers (5 trials, only 1 showing a significant difference; range of RRs, 0.34-0.86), use of oral vs nasal intubation (1 trial; RR, 0.52; 95% confidence interval, 0.24-1.13), subglottic secretion drainage vs standard endotracheal tubes (2 trials, 1 showing a significant difference; range of RRs, 0.46-0.57), and kinetic vs conventional beds (5 trials, only 1 showing a significant difference; range of RRs, 0.35-0.78).
Conclusions.— Some ventilator circuit and secretion management strategies may influence VAP rates in critically ill patients. Whether these strategies are adopted in practice depends on several factors such as the magnitude and precision of estimates of benefit and harm, as well as access, availability, and costs.
From the Department of Medicine, St Joseph's Hospital and McMaster University, Hamilton, Ontario (Dr Cook); Service de Reanimation Medicale, Hôpital de Poissy, Poissy, France (Dr De Jonghe); and Service de Reanimation Medicale, Hôpital Henri Mondor, Universite Paris-Val de Marne, Creteil, France (Drs Brochard and Brun-Buisson).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Hospital-Acquired and Ventilator-Associated Pneumonia
Grossman
ACCP Pulmonary Med Brd Rev 2009;25:391-400.
FULL TEXT
Survey of Cuff Management Practices in Intensive Care Units in Australia and New Zealand
Rose and Redl
Am J Crit Care 2008;17:428-435.
ABSTRACT
| FULL TEXT
Preventing Ventilator-Associated Pneumonia: Could Silver-Coated Endotracheal Tubes Be the Answer?
Chastre
JAMA 2008;300:842-844.
FULL TEXT
Profound effect of study design factors on ventilator-associated pneumonia incidence of prevention studies: benchmarking the literature experience
Hurley
J Antimicrob Chemother 2008;61:1154-1161.
ABSTRACT
| FULL TEXT
Preventing ventilator associated pneumonia
Brun-Buisson
BMJ 2007;334:861-862.
FULL TEXT
Rotational Bed Therapy to Prevent and Treat Respiratory Complications: A Review and Meta-Analysis
Goldhill et al.
Am J Crit Care 2007;16:50-61.
ABSTRACT
| FULL TEXT
Ventilator-Associated Pneumonia: A Review
Davis
J Intensive Care Med 2006;21:211-226.
ABSTRACT
Prevention and Diagnosis of Ventilator-Associated Pneumonia: A Survey on Current Practices in Southern Spanish ICUs
Sierra et al.
Chest 2005;128:1667-1673.
ABSTRACT
| FULL TEXT
Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia
Am. J. Respir. Crit. Care Med. 2005;171:388-416.
FULL TEXT
Prevention of nosocomial infections in acute respiratory failure patients
Girou
Eur Respir J 2003;22:72s-76s.
ABSTRACT
| FULL TEXT
Prevention of Ventilator-Associated Pneumonia: An Evidence-Based Systematic Review
Collard et al.
ANN INTERN MED 2003;138:494-501.
ABSTRACT
| FULL TEXT
Why Do Physicians Not Follow Evidence-Based Guidelines for Preventing Ventilator-Associated Pneumonia?* : A Survey Based on the Opinions of an International Panel of Intensivists
Rello et al.
Chest 2002;122:656-661.
ABSTRACT
| FULL TEXT
The pulmonary physician in critical care * 4: Nosocomial pneumonia
Ewig et al.
Thorax 2002;57:366-371.
ABSTRACT
| FULL TEXT
Infection Control in the ICU
Eggimann and Pittet
Chest 2001;120:2059-2093.
ABSTRACT
| FULL TEXT
Ventilator-associated pneumonia: European Task Force on ventilator-associated pneumonia Chairmen of the Task Force: A. Torres and J. Carlet
Members of the Task Force: et al.
Eur Respir J 2001;17:1034-1045.
FULL TEXT
Dynamic Changes in Apoptotic and Necrotic Cell Death Correlate with Severity of Ischemia-Reperfusion Injury in Lung Transplantation
FISCHER et al.
Am. J. Respir. Crit. Care Med. 2000;162:1932-1939.
ABSTRACT
| FULL TEXT
Ventilator-Associated Pneumonia
Morehead and Pinto
Arch Intern Med 2000;160:1926-1936.
ABSTRACT
| FULL TEXT
Guidelines in Pulmonary Medicine: A 25-Year Profile
Hackner et al.
Chest 1999;116:1046-1062.
ABSTRACT
| FULL TEXT
Ventilator-Associated Pneumonia in Critically Ill Patients
Kramer
ANN INTERN MED 1999;130:1027-1028.
FULL TEXT
Prevention of nosocomial bacterial pneumonia
Vincent
Thorax 1999;54:544-549.
FULL TEXT
Other Articles Noted
Evid. Based Nurs. 1998;1:100-104.
FULL TEXT
Risk Factors for ICU-Acquired Pneumonia
Cook and Kollef
JAMA 1998;279:1605-1606.
FULL TEXT
|
