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) |