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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Ventilator-Associated Pneumonia
18 March 2003 | Volume 138 Issue 6 | Page I-67
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine.
The summary below is from the full report titled "Prevention of Ventilator-Associated Pneumonia: An Evidence-Based Systematic Review." It is in the 18 March 2003 issue of Annals of Internal Medicine (volume 138, pages 494-501). The authors are HR Collard, S Saint, and MA Matthay.
What is the problem and what is known about it so far?
Ventilator-associated pneumonia (VAP) is a common and serious complication in critically ill patients who require a ventilator to breathe for them. This condition results in prolonged hospital stays and increased treatment costs. Ventilator-associated pneumonia is believed to result from aspiration (inhalation) of throat or stomach secretions contaminated with certain organisms.
Why did the authors do this review?
To help reduce the occurrence of VAP by providing physicians with information on which preventive methods are most effective.
How did the authors do this review?
The authors reviewed numerous clinical studies that followed critically ill patients through treatments designed to reduce their risk for VAP. The methods reviewed were 1) raising the heads of patients' beds to a 45-degree angle, 2) changing the drug used for prevention of stress ulcers, 3) continuously suctioning secretions in the throat, 4) regularly changing patients' position using automatic beds, 5) prescribing preventive antibiotics that target organisms associated with VAP, 6) changing ventilators' circuitry less frequently, and 7) tube feeding directly into the intestines to avoid gastroesophageal reflux (the return of stomach contents through the esophagus).
What did the authors find?
Raising the heads of patients' beds to a 45-degree angle reduced the occurrence of VAP. Medications called H2-antagonists, which are frequently used to prevent stress ulcers in critically ill patients, alter the stomach's pH level and may allow the growth of organisms that cause VAP. Sucralfate, another preventive drug that does not affect the stomach's pH level, reduced the occurrence of VAP but offered less protection against gastrointestinal bleeding. Mixed results were reported with continuous suctioning of throat secretions. This method may be appropriate in patients requiring ventilator assistance for more than 3 days. Automatic beds reduced the occurrence of VAP only in surgical and neurologic patients. Although targeted antibiotic treatment reduced occurrence, there are concerns about development of antibiotic resistance if these drugs are widely prescribed. Less frequent changes of ventilators' circuitry or of heat and moisture exchanger filters did not increase VAP incidence. No difference in VAP occurrence was found with intestinal tube feeding.
What are the implications of this review?
Doctors caring for patients on ventilators should consider 1) raising the heads of patients' beds to a 45-degree angle, 2) using sucralfate instead of H2-antagonists to prevent stress ulcers in patients at low to moderate risk for gastrointestinal bleeding, 3) continuously suctioning throat secretions in patients on ventilators for more than 3 days, and 4) using automatically repositioning beds (in surgical and neurologic patients only). The authors noted that no studies have evaluated combinations of these preventive measures and recommended future research in this area.
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