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Novel Preventive Strategies for Ventilator-associated Pneumonia

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Annual Update in Intensive Care and Emergency Medicine 2012

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM,volume 2012))

Abstract

Ventilator-associated pneumonia (VAP) is a complication of mechanical ventilation and is defined as the occurrence of pneumonia in patients undergoing mechanical ventilation for at least 48 hours. Clinical suspicion of VAP arises when new infiltrates are present on chest x-ray, and at least one of the following is present: Fever, leukocytosis, or purulent tracheo-bronchial secretions.

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References

  1. American Thoracic Society; Infectious Diseases Society of America (2005) Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcareassociated pneumonia. Am J Respir Crit Care Med 171: 388–416

    Article  Google Scholar 

  2. Bekaert M, Timsit JF, Vansteelandt S, et al (2011) Attributable mortality of ventilator associated pneumonia: A reappraisal using causal analysis. Am J Respir Crit Care Med 184: 1133–1139

    Article  PubMed  Google Scholar 

  3. Morris AC, Hay AW, Swann DG, et al (2011) Reducing ventilator-associated pneumonia in intensive care: Impact of implementing a care bundle. Crit Care Med 39: 2218–2224

    Article  PubMed  Google Scholar 

  4. Torres A, Gatell JM, Aznar E, et al (1995) Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation. Am J Respir Crit Care Med 152: 137–141

    Article  PubMed  CAS  Google Scholar 

  5. Griffiths J, Barber VS, Morgan L, Young JD (2005) Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ 330: 1243

    Article  PubMed  Google Scholar 

  6. Terragni PP, Antonelli M, Fumagalli R, et al (2010) Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA 303: 1483–1489

    Article  PubMed  CAS  Google Scholar 

  7. Squadrone V, Massaia M, Bruno B (2010) Early CPAP prevents evolution of acute lung injury in patients with hematologic malignancy. Intensive Care Med 36: 1666–1674

    Article  PubMed  Google Scholar 

  8. Blackwood B, Alderdice F, Burns KE, Cardwell CR, Lavery G, O’Halloran P (2010) Protocolized versus non-protocolized weaning for reducing the duration of mechanical ventilation in critically ill adult patients. Cochrane Database Syst Rev 12: CD006904

    Google Scholar 

  9. Torres A, el-Ebiary M, Gonz’alez J, et al (1993) Gastric and pharyngeal flora in nosocomial pneumonia acquired during mechanical ventilation. Am Rev Respir Dis 148: 352–357

    Article  PubMed  CAS  Google Scholar 

  10. Herzig SJ, Howell MD, Ngo LH, Marcantonio ER (2009) Acid-suppressive medication use and the risk for hospital-acquired pneumonia. JAMA 301: 2120–2128

    Article  PubMed  CAS  Google Scholar 

  11. Bergmans DC, Bonten MJ, Gaillard CA, et al (2001) Prevention of ventilator-associated pneumonia by oral decontamination: a prospective, randomized, double-blind, placebocontrolled study. Am J Respir Crit Care Med 164: 382–388

    Article  PubMed  CAS  Google Scholar 

  12. Koeman M, van der Ven AJ, Hak E, et al (2006) Oral decontamination with chlorhexidine reduces the incidence of ventilator-associated pneumonia. Am J Respir Crit Care Med 173: 1348–1355

    Article  PubMed  CAS  Google Scholar 

  13. Flanagan ME, Welsh CA, Kiess C, Hoke S, Doebbeling BN (2011) Agency for Healthcare Research and Quality (AHRQ) Hospital-Acquired Infections (HAI) Collaborative. A national collaborative for reducing health care?associated infections: Current initiatives, challenges, and opportunities. Am J Infect Control 39: 685–689

    Article  PubMed  Google Scholar 

  14. Cairns S, Thomas JG, Hooper SJ et al (2011) Molecular analysis of microbial communities in endotracheal tube biofilms. PLoS One 6: e14759

    Article  PubMed  CAS  Google Scholar 

  15. Inglis TJ, Millar MR, Jones JG, Robinson DA (1989) Tracheal tube biofilm as a source of bacterial colonization of the lung. J Clin Microbiol 27: 2014–2018

    PubMed  CAS  Google Scholar 

  16. Adair CG, Gorman SP, Feron BM, et al (1999) Implications of endotracheal tube biofilm for ventilator-associated pneumonia. Intensive Care Med 25: 1072–1076

    Article  PubMed  CAS  Google Scholar 

  17. Berra L, Coppadoro A, Bittner EA, et al (2012) A clinical assessment of the Mucus Shaver: A device to keep the endotracheal tube free from secretions. Crit Care Med 40: 119–124

    Article  PubMed  Google Scholar 

  18. Seegobin RD, van Hasselt GL (1984) Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs. Br Med J (Clin Res Ed) 288: 965–968

    Article  CAS  Google Scholar 

  19. Nseir S, Brisson H, Marquette CH, et al (2009) Variations in endotracheal cuff pressure in intubated critically ill patients: prevalence and risk factors. Eur J Anaesthesiol 26: 229–234

    Article  PubMed  Google Scholar 

  20. Nseir S, Zerimech F, Fournier C, et al (2011) Continuous control of tracheal cuff pressure and microaspiration of gastric contents in critically ill patients. Am J Respir Crit Care Med 184: 1041–1047

    Article  PubMed  Google Scholar 

  21. Berra L, De Marchi L, Panigada M, Yu ZX, Baccarelli A, Kolobow T (2004) Evaluation of continuous aspiration of subglottic secretion in an in vivo study. Crit Care Med 32: 2071–2078

    Article  PubMed  Google Scholar 

  22. Lacherade JC, De Jonghe B, Guezennec P, et al (2010) Intermittent subglottic secretion drainage and ventilator-associated pneumonia: a multicenter trial. Am J Respir Crit Care Med 182: 910–917

    Article  PubMed  Google Scholar 

  23. Muscedere J, Rewa O, McKechnie K, Jiang X, Laporta D, Heyland DK (2011) Subglottic secretion drainage for the prevention of ventilator-associated pneumonia: A systematic review and meta-analysis. Crit Care Med 39: 1985–1991

    Article  PubMed  Google Scholar 

  24. Li Bassi G, Curto F, Zanella A, Stylianou M, Kolobow T (2007) A 72-hour study to test the efficacy and safety of the “Mucus Slurper” in mechanically ventilated sheep. Crit Care Med 35: 906–911

    Article  PubMed  Google Scholar 

  25. Berra L, Curto F, Li Bassi G, et al (2008) Antimicrobial-coated endotracheal tubes: an experimental study. Intensive Care Med 34: 1020–1029

    Article  PubMed  Google Scholar 

  26. Raad II, Mohamed JA, Reitzel RA, et al (2011) The prevention of biofilm colonization by multidrug-resistant pathogens that cause ventilator-associated pneumonia with antimicrobial-coated endotracheal tubes. Biomaterials 32: 2689–2694

    Article  PubMed  CAS  Google Scholar 

  27. Kollef MH, Afessa B, Anzueto A, et al (2008) Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial. JAMA 300: 805–813

    Article  PubMed  CAS  Google Scholar 

  28. Shorr AF, Zilberberg MD, Kollef M (2009) Cost-effectiveness analysis of a silver-coated endotracheal tube to reduce the incidence of ventilator-associated pneumonia. Infect Control Hosp Epidemiol 30: 759–763

    Article  PubMed  Google Scholar 

  29. Zanella A, Scaravilli V, Isgrò S, et al (2011) Fluid leakage across tracheal tube cuff, effect of different cuff material, shape, and positive expiratory pressure: a bench-top study. Intensive Care Med 37: 343–347

    Article  PubMed  Google Scholar 

  30. Dave MH, Frotzler A, Spielmann N, Madjdpour C, Weiss M (2010) Effect of tracheal tube cuff shape on fluid leakage across the cuff: an in vitro study. Br J Anaesth 105: 538–543

    Article  PubMed  CAS  Google Scholar 

  31. Kolobow T, Cressoni M, Epp M, Corti I, Cadringher P, Zanella A (2011) Comparison of a novel lycra endotracheal tube cuff to standard polyvinyl chloride cuff and polyurethane cuff for fluid leak prevention. Respir Care 56: 1095–1099

    Article  PubMed  Google Scholar 

  32. Poelaert J, Depuydt P, De Wolf A, Van de Velde S, Herck I, Blot S (2008) Polyurethane cuffed endotracheal tubes to prevent early postoperative pneumonia after cardiac surgery: a pilot study. J Thorac Cardiovasc Surg 135: 771–776

    Article  PubMed  Google Scholar 

  33. Miller MA, Arndt JL, Konkle MA, et al (2011) A polyurethane cuffed endotracheal tube is associated with decreased rates of ventilator-associated pneumonia. J Crit Care 26: 280–286

    Article  PubMed  Google Scholar 

  34. Lorente L, Lecuona M, Jiménez A, Mora ML, Sierra A (2007) Influence of an endotracheal tube with polyurethane cuff and subglottic secretion drainage on pneumonia. Am J Respir Crit Care Med 176: 1079–1083

    Article  PubMed  Google Scholar 

  35. Torres A, Serra-Batlles J, Ros E, et al (1992) Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: the effect of body position. Ann Intern Med 116: 540–543

    Article  PubMed  CAS  Google Scholar 

  36. Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogué S, Ferrer M (1999) Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet 354: 1851–1858

    Article  PubMed  CAS  Google Scholar 

  37. Panigada M, Berra L (2011) Gravity. It’s not just a good idea. It’s the law. Minerva Anestesiol 77: 127–128

    PubMed  CAS  Google Scholar 

  38. Li Bassi G, Torres A (2011) Ventilator-associated pneumonia: role of positioning. Curr Opin Crit Care 17: 57–63

    Article  PubMed  Google Scholar 

  39. Bassi GL, Zanella A, Cressoni M, Stylianou M, Kolobow T (2008) Following tracheal intubation, mucus flow is reversed in the semirecumbent position: possible role in the pathogenesis of ventilator-associated pneumonia. Crit Care Med 36: 518–525

    Article  Google Scholar 

  40. Mauri T, Berra L, Kumwilaisak K, et al (2010) Lateral-horizontal patient position and horizontal orientation of the endotracheal tube to prevent aspiration in adult surgical intensive care unit patients: a feasibility study. Respir Care 55: 294–302

    PubMed  Google Scholar 

  41. Gravity-VAP network (2010) Prospective, randomized, multi-center trial of lateral trendelenburg versus semi-recumbent body position in mechanically ventilated patients for the prevention of ventilator-associated pneumonia. Available at http://www.gravityvaptrial. org/joomla/documents/summaryProtocol.pdf. Accessed November 2011

    Google Scholar 

  42. Nakagawa NK, Franchini ML, Driusso P, de Oliveira LR, Saldiva PH, Lorenzi-Filho G (2005) Mucociliary clearance is impaired in acutely ill patients. Chest 128: 2772–2777

    Article  PubMed  Google Scholar 

  43. Delaney A, Gray H, Laupland KB, Zuege DJ (2006) Kinetic bed therapy to prevent nosocomial pneumonia in mechanically ventilated patients: a systematic review and meta-analysis. Crit Care 10: R70

    Article  PubMed  Google Scholar 

  44. Siempos II, Ntaidou TK, Falagas ME (2010) Impact of the administration of probiotics on the incidence of ventilator-associated pneumonia: a meta-analysis of randomized controlled trials. Crit Care Med 38: 954–962

    Article  PubMed  Google Scholar 

  45. Marik PE, Zaloga GP (2003) Gastric versus post-pyloric feeding: a systematic review. Crit Care 7: R 46–51

    Article  Google Scholar 

  46. White H, Sosnowski K, Tran K, Reeves A, Jones M (2009) A randomised controlled comparison of early post-pyloric versus early gastric feeding to meet nutritional targets in ventilated intensive care patients. Crit Care 13: R187

    Article  PubMed  Google Scholar 

  47. Artinian V, Krayem H, DiGiovine B (2006) Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients. Chest 129: 960–967

    Article  PubMed  Google Scholar 

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Authors
  1. A. Coppadoro
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  2. E. A. Bittner
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  3. L. Berra
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Editor information

Editors and Affiliations

  1. Department of Intensive Care Erasme Hospital, Université libre de Bruxelles, Route de Lennik 808, B-1070, Brussels, Belgium

    Jean-Louis Vincent (Head) (Head)

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© 2012 Springer-Verlag Berlin Heidelberg

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Coppadoro, A., Bittner, E.A., Berra, L. (2012). Novel Preventive Strategies for Ventilator-associated Pneumonia. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2012. Annual Update in Intensive Care and Emergency Medicine, vol 2012. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-25716-2_27

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  • DOI: https://doi.org/10.1007/978-3-642-25716-2_27

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-25715-5

  • Online ISBN: 978-3-642-25716-2

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