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Semirecumbency Prevents Nosocomial Pneumonia in Mechanically Ventilated Patients

  • M. B. Drakulovic
  • A. Torres
Conference paper

Abstract

Nosocomial pneumonia is the most common infection in the intensive care unit (ICU) [1]. Nosocomial pneumonia (NP) in mechanically ventilated (MV) or ventilator-associated pneumonia (VAP) typically refers to pneumonia developing after 48 hours following endotracheal intubation and MV [2]. Infections restricted to a series of MV patients within the ICU revealed that VAP accounts for approximately 90% of the infections in patients requiring assisted ventilation [3]. The European [4] and Spanish [5] multicenter studies have associated MV in ICU patients with almost 3-fold and 23-fold increased risk of NP, respectively, compared with non ventilated subjects. Furthermore, National Nosocomial Infections Surveillance (NNIS) system [6] reported approximately 9.3 times higher incidence density rates of VAP than nonventilator-associated pneumonia within the ICU, ranging from 2.6 times higher in the respiratory ICU to 19 times higher in the burn ICU. Nosocomial pneumonia is also a leading cause of death in ICUs [7], resulting in a significant 2 to 10-fold increase in the mortality rate [8, 9, 10] and the occurrence is shown to be an independent determinant of hospital mortality [11]. Recent inferences have been made, indicating that VAP markedly increases morbidity by affecting the ICU length of stay [12, 13] and the duration of MV [14, 15]. Two investigations reported that VAP caused a significant excess of the ICU length of stay in one clinical trial [12] and prolongation of the ICU hospitalization for 4 days in another clinical trial [13]. In addition, VAP increased almost 3-fold more than MV in a multicenter prospective study [14] or 9 days in a matched cohort investigation [15]. Finally, there is no doubt that VAP substantially increased the hospital costs for the survivors [16]. Papazian et al. estimated that each episode of VAP costs the hospital an additional $ 7 752 [15].

Keywords

Intensive Care Unit Patient Enteral Nutrition Respir Crit Enteral Feeding Nosocomial Pneumonia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Italia 2002

Authors and Affiliations

  • M. B. Drakulovic
    • 1
  • A. Torres
    • 1
  1. 1.Respiratory Intensive Care Unit, Department of Pneumology, Clinical Institute of Pneumology and Thoracic Surgery, Clinical HospitalInstitute of Biomedical Investigation Augusti Pi i Sunyer, University of BarcelonaBarcelonaSpain

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