Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia

被引:307
作者
Dodek, P
Keenan, S
Cook, D
Heyland, D
Jacka, M
Hand, L
Muscedere, J
Foster, D
Mehta, N
Hall, R
Brun-Buisson, C
机构
[1] Univ British Columbia, Vancouver, BC V5Z 1M9, Canada
[2] Queens Univ, Kingston, ON K7L 3N6, Canada
[3] McMaster Univ, Hamilton, ON L8S 4L8, Canada
[4] Hotel Dieu Grace Hosp, Windsor, CT USA
[5] Univ Toronto, Toronto, ON, Canada
[6] Sudbury Reg Hosp, Sudbury, ON, Canada
[7] Univ Alberta Hosp, Edmonton, AB T6G 2B7, Canada
[8] Dalhousie Univ, Halifax, NS, Canada
[9] Univ Paris 12, Hop Henri Mondor, F-94010 Creteil, France
关键词
D O I
10.7326/0003-4819-141-4-200408170-00011
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Ventilator-associated pneumonia (VAP) is an important patient safety issue in critically ill patients. Purpose: To develop an evidence-based guideline for the prevention of VAP. Data Sources: MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews. Study Selection: The authors systematically searched for relevant randomized, controlled trials and systematic reviews that involved mechanically ventilated adults and were published before 1 April 2003. Data Extraction: Physical, positional, and pharmacologic interventions that may influence the development of VAP were considered. Independently and in duplicate, the authors scored the validity of trials; the effect size and confidence intervals; the homogeneity of results; and safety, feasibility, and economic issues. Data Synthesis: Recommended. The orotracheal route of intubation, changes of ventilator circuits only for each new patient and if the circuits are soiled, use of closed endotracheal suction systems that are changed for each new patient and as clinically indicated, heat and moisture exchangers in the absence of contraindications, weekly changes of heat and moisture exchangers, and semi-recumbent positioning in the absence of contraindications. Consider subglottic secretion drainage and kinetic beds. Not recommended: Sucralfate to prevent VAP in patients at high risk for gastrointestinal bleeding and topical antibiotics to prevent VAP. Because of insufficient or conflicting evidence, no recommendations were made about systematically searching for maxillary sinusitis, chest physiotherapy, the timing of tracheostomy, prone positioning, prophylactic intravenous antibiotics, or intravenous plus topical antibiotics. Limitations: No formal economic analysis was performed, and patient perspectives were not considered. Conclusion: if effectively implemented, this guideline may decrease the morbidity, mortality, and costs of VAP in mechanically ventilated patients.
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页码:305 / 313
页数:9
相关论文
共 105 条
[1]  
AERDTS SJA, 1993, BRIT MED J, V307, P525
[2]   NOSOCOMIAL SINUSITIS IN VENTILATED PATIENTS - NASOTRACHEAL VERSUS OROTRACHEAL INTUBATION [J].
BACH, A ;
BOEHRER, H ;
SCHMIDT, H ;
GEISS, HK .
ANAESTHESIA, 1992, 47 (04) :335-339
[3]   Pneumonia in intubated trauma patients - Microbiology and outcomes [J].
Baker, AM ;
Meredith, JW ;
Haponik, EF .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1996, 153 (01) :343-349
[4]   PROPHYLAXIS FOR STRESS-RELATED GASTRIC HEMORRHAGE IN THE MEDICAL INTENSIVE-CARE UNIT - A RANDOMIZED, CONTROLLED, SINGLE-BLIND STUDY [J].
BENMENACHEM, T ;
FOGEL, R ;
PATEL, RV ;
TOUCHETTE, M ;
ZAROWITZ, BJ ;
HADZIJAHIC, N ;
DIVINE, G ;
VERTER, J ;
BRESALIER, RS .
ANNALS OF INTERNAL MEDICINE, 1994, 121 (08) :568-+
[5]   Prone position as prevention of lung injury in comatose patients: a prospective, randomized, controlled study [J].
Beuret, P ;
Carton, MJ ;
Nourdine, K ;
Kaaki, M ;
Tramoni, G ;
Ducreux, JC .
INTENSIVE CARE MEDICINE, 2002, 28 (05) :564-569
[6]  
Black N, 1999, J Health Serv Res Policy, V4, P236
[7]   Clinical utility of hygroscopic heat and moisture exchangers in intensive care patients [J].
Boots, RJ ;
Howe, S ;
George, N ;
Harris, FM ;
Faoagali, J .
CRITICAL CARE MEDICINE, 1997, 25 (10) :1707-1712
[8]   INFLUENCE OF NOSOCOMIAL INFECTION ON MORTALITY-RATE IN AN INTENSIVE-CARE UNIT [J].
BUENOCAVANILLAS, A ;
DELGADORODRIGUEZ, M ;
LOPEZLUQUE, A ;
SCHAFFINOCANO, S ;
GALVEZVARGAS, R .
CRITICAL CARE MEDICINE, 1994, 22 (01) :55-60
[9]  
Campbell GD, 1996, AM J RESP CRIT CARE, V153, P1711
[10]   NOSOCOMIAL PNEUMONIA - A MULTIVARIATE-ANALYSIS OF RISK AND PROGNOSIS [J].
CELIS, R ;
TORRES, A ;
GATELL, JM ;
ALMELA, M ;
RODRIGUEZROISIN, R ;
AGUSTIVIDAL, A .
CHEST, 1988, 93 (02) :318-324