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In Reply: We agree with Dr Fujita that it is important to identify patients who are at highest risk for HAP and highest risk for stress ulcers to more accurately weigh the risks and benefits of prophylactic acid-suppressive medication use. Furthermore, as Fujita points out, it would be useful to know which risk factors for HAP are modified by acid-suppressive medication use. In our model there were 27 significant predictors of HAP. We performed stepwise variable selection methods as suggested by Fujita, but a small number of dominant predictors of HAP did not emerge. Therefore, the analyses required to examine effect modification between acid-suppressive medication and the 27 independent predictors of HAP in our cohort are beyond the scope of this reply.

Drs McCullough and Benson point out the well-studied relationship between body position and aspiration among mechanically ventilated patients. They cite the study by Metheny et al,¹ in which . . . [Full Text of this Article]

Shoshana J. Herzig, MD
sherzig@bidmc.harvard.edu
Division of General Medicine and Primary Care

Michael D. Howell, MD, MPH
Division of Pulmonary and Critical Care

Edward R. Marcantonio, MD, SM
Division of General Medicine and Primary Care
Beth Israel Deaconess Medical Center
Boston, Massachusetts

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