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Evid Based Nurs 6:112 doi:10.1136/ebn.6.4.112
  • Treatment

Review: several interventions prevent ventilator associated pneumonia in critically ill patients

Effectiveness of interventions for preventing ventilator associated pneumonia (VAP) in critically ill patients*

Intervention Results
*RCT = randomised controlled trial, MA = meta-analysis, NA = not available.
†Information on comparison group provided by author.
Semirecumbent v supine positioning† (3 trials, n=116) ↓ VAP (1 RCT, n=86); ↓ gastroesophageal reflux and aspiration events (2 controlled clinical trials, n=30); no difference in mortality (1 RCT, n=86)
Stress ulcer prophylaxis:sucralfate v H2 antagonists (7 MAs of >20 RCTs; 1 recent RCT, n=1200) ↓ VAP (4 of 7 MAs), 3 MAs found no difference; ↓ mortality (3 of 4 MAs); equivocal evidence regarding increased gastrointestinal bleeding (2 MAs), 1 recent RCT (n=1200) found increased bleeding
Aspiration of subglottic secretions v none† (3 RCTs, n=641) no difference in VAP (2 RCTs, n=496), reduced VAP (1 RCT, n=145), delayed time to VAP development (3 RCTs, n=641); no difference in mortality (3 RCTs, n=641)
Oscillating v standard non-oscillating beds† (1 MA of 6 RCTs; 1 recent RCT, n=103) ↓ pneumonia (1 MA), no difference (1 RCT, n=103); no difference in mortality (1 MA, 1 RCT, n=103)
Selective digestive tract decontamination v none† (7 MAs of >40 RCTs) ↓ VAP (7 MAs); ↓ mortality (4 of 7 MAs)
    Topical + systemic antibiotics v none† ↓ VAP (3 of 3 MAs); ↓ mortality (4 of 4 MAs)
    Topical antibiotics alone v none† ↓ VAP (3 of 3 MAs); no difference in mortality (4 of 4 MAs)
Ventilator circuit management (4 RCTs, n=NA)
    Fewer v more changes (4 RCTs) no difference in VAP (4 RCTs)
    Fewer v more changes in heat and moisture exchangers (1 RCT) no difference in VAP (1 RCT)
    Heat and moisture exchanger v humidifier (1 MA of 5 RCTs) no difference in VAP (4 of 5 RCTs in 1 MA); no difference in mortality (4 of 4 RCTs in 1 MA)
Enteral feeding methods (4 RCTs, n=504)
    Small intestinal v gastric feeding no difference in VAP or mortality (1 RCT, n=44)
    Metoclopramide v none† no difference in VAP or mortality (1 RCT, n=305)
    Acidified v normal feedings† no difference in VAP or mortality (1 RCT, n=95)
    Intermittent v continuous feeding no difference in VAP or mortality (1 RCT, n=60)

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