Journal Information
Vol. 46. Issue 4.
Pages 188-195 (April 2010)
Share
Share
Download PDF
More article options
Vol. 46. Issue 4.
Pages 188-195 (April 2010)
Review Article
Full text access
Non-Pharmacological Prevention of Ventilator Associated Pneumonia
Prevención no farmacológica de la neumonía asociada a ventilación mecánica
Visits
9960
Luis Aurelio Díaza, Mireia Llauradób, Jordi Rellob,c, Marcos I. Restrepod,
Corresponding author
restrepom@uthscsa.edu

Corresponding author.
a Geisinger Health System, Danville, Pensilvania, United States, Tarragona, Spain
b CIBER de Enfermedades Respiratorias (CibeRes), Hospital Universitario Joan XXIII, Tarragona, Spain
c Institut d’Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, Tarragona, Spain
d VERDICT, South Texas Veterans Health Care System Audie L. Murphy Division, University of Texas Health Science Center at San Antonio, Division of Pulmonary and Critical Care Medicine, San Antonio, Texas, USA
This item has received
Article information
Abstract
Bibliography
Download PDF
Statistics
Abstract

Ventilator-associated pneumonia (VAP) is the first cause of mortality due to nosocomial infections in the intensive care unit. Its incidence ranges from 9% to 67% of patients on mechanical ventilation. Risk factors are multiple and are associated with prolonged stays in hospital and intensive care units. Additional costs for each episode of VAP range from €9,000 to €31,000.

Thus, its prevention should be considered as a priority. This prevention could decrease associated morbidity, mortality, costs, and increase patient safety.

Keywords:
Ventilator-associated pneumonia
Artificial respiration
Cross infection
Intensive care unit
Disease prevention
Resumen

La neumonía asociada a ventilación mecánica es la primera causa de mortalidad por infecciones nosocomiales en la unidad de cuidados intensivos. Su incidencia oscila entre el 9 y el 67% de los pacientes que requieren ventilación mecánica. Hay múltiples factores de riesgo asociados y aumenta significativamente la estancia en la unidad de cuidados intensivos y en el hospital. El coste adicional por cada neumonía asociada a ventilación mecánica oscila entre 9.000 y 31.000 €.

Por tanto, su prevención debe considerarse una prioridad. Ésta podría disminuir tanto la morbimortalidad asociada como el coste de la atención, y mejorar la seguridad del paciente.

Palabras clave:
Neumonía asociada a ventilación mecánica
Respiración artificial
Infección hospitalaria
Unidad de cuidados intensivos
Prevención de enfermedades
Full text is only aviable in PDF
References
[1.]
American Thoracic Society, Infectious Diseases Society of America.
Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia.
Am J Respir Crit Care Med, 171 (2005), pp. 388-416
[2.]
O.C. Tablan, L.J. Anderson, R. Besser, C. Bridges, R. Hajjeh.
Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee.
MMWR Recomm Rep, 53 (2004), pp. 1-36
[3.]
J. Rello, D.A. Ollendorf, G. Oster, M. Vera-Llonch, L. Bellm, R. Redman, et al.
Epidemiology and outcomes of ventilator-associated pneumonia in a large US database.
Chest, 122 (2002), pp. 2115-2121
[4.]
J. Chastre, J.Y. Fagon.
Ventilator-associated pneumonia.
Am J Respir Crit Care Med, 165 (2002), pp. 867-903
[5.]
National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control. 2004;32:470-85.
[6.]
D.J. Cook, M.H. Kollef.
Risk factors for ICU-acquired pneumonia.
JAMA, 279 (1998), pp. 1605-1606
[7.]
M.H. Kollef.
Epidemiology and risk factors for nosocomial pneumonia. Emphasis on prevention.
Clin Chest Med, 20 (1999), pp. 653-670
[8.]
J.Y. Fagon, J. Chastre, A.J. Hance, Y. Domart, J.L. Trouillet, C. Gibert.
Evaluation of clinical judgment in the identification and treatment of nosocomial pneumonia in ventilated patients.
Chest, 103 (1993), pp. 547-553
[9.]
D.E. Craven, K.A. Steger.
Nosocomial pneumonia in mechanically ventilated adult patients: epidemiology and prevention in 1996.
Semin Respir Infect, 11 (1996), pp. 32-53
[10.]
National Nosocomial Infections Surveillance (NNIS) System report, data summary from January 1990-May 1999, issued June 1999. Am J Infect Control. 1999; 27:520-32.
[11.]
D.L. George, P.S. Falk, R.G. Wunderink, K.V. Leeper, G.U. Meduri, E.L. Steere, et al.
Epidemiology of ventilator-acquired pneumonia based on protected bronchoscopic sampling.
Am J Respir Crit Care Med, 158 (1998), pp. 1839-1847
[12.]
J. Rello, V. Ausina, M. Ricart, J. Castella, G. Prats.
Impact of previous antimicrobial therapy on the etiology and outcome of ventilator-associated pneumonia.
Chest, 104 (1993), pp. 1230-1235
[13.]
J.Y. Fagon, J. Chastre, A.J. Hance, P. Montravers, A. Novara, C. Gibert.
Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay.
Am J Med, 94 (1993), pp. 281-288
[14.]
D.K. Heyland, D.J. Cook, L. Griffith, S.P. Keenan, C. Brun-Buisson, The Canadian Critical Trials Group.
The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient.
Am J Respir Crit Care Med, 159 (1999), pp. 1249-1256
[15.]
E. Tejerina, F. Frutos-Vivar, M.I. Restrepo, A. Anzueto, F. Abroug, F. Palizas, et al.
Incidence, risk factors, and outcome of ventilator-associated pneumonia.
J Crit Care, 21 (2006), pp. 56-65
[16.]
K. Agbaht, E. Díaz, E. Muñoz, T. Lisboa, F. Gómez, P.O. Depuydt, et al.
Bacteremia in patients with ventilator-associated pneumonia is associated with increased mortality: a study comparing bacteremic vs. nonbacteremic ventilator-associated pneumonia.
Crit Care Med, 35 (2007), pp. 2064-2070
[17.]
I. Kappstein, G. Schulgen, U. Beyer, K. Geiger, M. Schumacher, F.D. Daschner.
Prolongation of hospital stay and extra costs due to ventilator-associated pneumonia in an intensive care unit.
Eur J Clin Microbiol Infect Dis, 11 (1992), pp. 504-508
[18.]
D.K. Warren, S.J. Shukla, M.A. Olsen, M.H. Kollef, C.S. Hollenbeak, M.J. Cox, et al.
Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center.
Crit Care Med, 31 (2003), pp. 1312-1317
[19.]
R. Resar, P. Pronovost, C. Haraden, T. Simmonds, T. Rainey, T. Nolan.
Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia.
Jt Comm J Qual Patient Saf, 31 (2005), pp. 243-248
[20.]
P. Youngquist, M. Carroll, M. Farber, D. Macy, P. Madrid, J. Ronning, et al.
Implementing a ventilator bundle in a community hospital.
Jt Comm J Qual Patient Saf, 33 (2007), pp. 219-225
[21.]
T. Lansford, M. Moncure, E. Carlton, R. Endress, N. Shik, K. Udobi, et al.
Efficacy of a pneumonia prevention protocol in the reduction of ventilator-associated pneumonia in trauma patients.
Surg Infect, 8 (2007), pp. 505-510
[22.]
S.I. Blot, S. Labeau, D. Vandijck, P. Van Aken, B. Claes.
Executive Board of the Flemish Society of Critical Care Nurses. Evidence-based guidelines for the prevention of ventilator-associated pneumonia: results of a knowledge test among intensive care nurses.
Intensive Care Med, 33 (2007), pp. 1463-1467
[23.]
J. Rello, C. Lorente, M. Bodí, E. Díaz, M. Ricart, M.H. Kollef.
Why do physicians not follow evidence-based guidelines for preventing ventilator-associated pneumonia?.
Chest, 122 (2002), pp. 656-661
[24.]
M. Ricart, C. Lorente, E. Díaz, M.H. Kollef, J. Rello.
Nursing adherence with evidence-based guidelines for preventing ventilator-associated pneumonia.
Crit Care Med, 31 (2003), pp. 2693-2696
[25.]
R. Sierra, E. Benítez, C. León, J. Rello.
Prevention and diagnosis of ventilator-associated pneumonia.
Chest, 128 (2005), pp. 1667-1673
[26.]
F.G. De Rosa, M. Michelazzo, N. Pagani, G. Di Perri, V.M. Ranieri.
Prevention and diagnosis of ventilator-associated pneumonia.
Chest, 135 (2009), pp. 881-882
[27.]
A. Torres, J. Carlet.
Ventilator-associated pneumonia. European Task Force on ventilator-associated pneumonia.
Eur Respir J, 17 (2001), pp. 1034-1045
[28.]
P. Dodek, S. Keenan, D. Cook, D. Heyland, M. Jacka, L. Hand, et al.
Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia.
Ann Intern Med, 141 (2004), pp. 305-313
[29.]
F.S. Rhame, A. Streifel, C. McComb, M. Boyle.
Bubbling humidifiers produce microaerosols which can carry bacteria.
Infect Control, 7 (1986), pp. 403-407
[30.]
J.M. Boyce, D. Pittet.
Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force.
Am J Infect Control, 30 (2002), pp. 1-46
[31.]
J.S. Garner.
Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee.
Infect Control Hosp Epidemiol, 17 (1996), pp. 53-80
[32.]
M.H. Kollef.
The prevention of ventilator-associated pneumonia.
N Engl J Med, 340 (1999), pp. 627-634
[33.]
R.A. Weinstein.
Epidemiology and control of nosocomial infections in adult intensive care units.
Am J Med, 91 (1991), pp. 179S-184S
[34.]
D.G. Maki.
Control of colonization and transmission of pathogenic bacteria in the hospital.
Ann Intern Med, 89 (1978), pp. 777-780
[35.]
E.L. Larson.
Persistent carriage of gram-negative bacteria on hands.
Am J Infect Control, 9 (1981), pp. 112-119
[36.]
F.D. Daschner.
The transmission of infections in hospitals by staff carriers, methods of prevention and control.
Infect Control, 6 (1985), pp. 97-99
[37.]
M.J. Bonten.
Controversies on diagnosis and prevention of ventilator-associated pneumonia.
Diagn Microbiol Infect Dis, 34 (1999), pp. 199-204
[38.]
M.J. Bonten, D.C. Bergmans, I.M. Hoepelman, E.E. Stobberingh.
Ventilator-associated pneumonia; controversies with respect to diagnosis, pathogenesis, therapy and prevention.
Ned Tijdschr Geneeskd, 143 (1999), pp. 726-730
[39.]
D. Pittet, S. Hugonnet, S. Harbarth, P. Mourouga, V. Sauvan, S. Touveneau, et al.
Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme.
Lancet, 356 (2000), pp. 1307-1312
[40.]
J. Needleman, P. Buerhaus, S. Mattke, M. Stewart, K. Zelevinsky.
Nurse-staffing levels and the quality of care in hospitals.
N Engl J Med, 346 (2002), pp. 1715-1722
[41.]
S.H. Cho, S. Ketefian, V.H. Barkauskas, D.G. Smith.
The effects of nurse staffing on adverse events, morbidity, mortality, and medical costs.
Nurs Res, 52 (2003), pp. 71-79
[42.]
G.P. Marelich, S. Murin, F. Battistella, J. Inciardi, T. Vierra, M. Roby.
Protocol weaning of mechanical ventilation in medical and surgical patients by respiratory care practitioners and nurses:effect on weaning time and incidence of ventilator-associated pneumonia.
Chest, 118 (2000), pp. 459-467
[43.]
M.H. Kollef, B. Von Harz, D. Prentice, S.D. Shapiro, P. Silver, R. St John, et al.
Patient transport from intensive care increases the risk of developing ventilator-associated pneumonia.
Chest, 112 (1997), pp. 765-773
[44.]
N. Bercault, M. Wolf, I. Runge, J.C. Fleury, T. Boulain.
Intrahospital transport of critically ill ventilated patients:a risk factor for ventilator-associated pneumonia—a matched cohort study.
Crit Care Med, 33 (2005), pp. 2471-2478
[45.]
R.W. Haley, D.R. Schaberg, K.B. Crossley, S.D. Von Allmen, J.E. McGowan.
Extra charges and prolongation of stay attributable to nosocomial infections: a prospective interhospital comparison.
Am J Med, 70 (1981), pp. 51-58
[46.]
R. Greene, S. Thompson, H.S. Jantsch, R. Teplick, D.J. Cullen, E.M. Greene, et al.
Detection of pooled secretions above endotracheal-tube cuffs: value of plain radiographs in sheep cadavers and patients.
AJR Am J Roentgenol, 163 (1994), pp. 1333-1337
[47.]
J. Rello, R. Sonora, P. Jubert, A. Artigas, M. Rue, J. Valles.
Pneumonia in intubated patients: role of respiratory airway care.
Am J Respir Crit Care Med, 154 (1996), pp. 111-115
[48.]
M.H. Kollef.
Prevention of hospital-associated pneumonia and ventilator-associated pneumonia.
Crit Care Med, 32 (2004), pp. 1396-1405
[49.]
L. Brochard, J. Mancebo, M. Wysocki, F. Lofaso, G. Conti, A. Rauss, et al.
Non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease.
N Engl J Med, 333 (1995), pp. 817-822
[50.]
S.P. Keenan.
Non-invasive positive pressure ventilation in acute respiratory failure.
JAMA, 284 (2000), pp. 2376-2378
[51.]
A. Esteban, F. Frutos-Vivar, N.D. Ferguson, Y. Arabi, C. Apezteguia, M. González, et al.
Non-invasive positive-pressure ventilation for respiratory failure after extubation.
N Engl J Med, 350 (2004), pp. 2452-2460
[52.]
M. Ferrer, A. Esquinas, F. Arancibia, T.T. Bauer, G. González, A. Carillo, et al.
Non-invasive ventilation during persistent weaning failure: a randomized controlled trial.
Am J Respir Crit Care Med, 168 (2003), pp. 70-76
[53.]
K.E.A. Burns, N.K.J. Adhikari, M.O. Meade.
A meta-analysis of non-invasive weaning to facilitate liberation from mechanical ventilation.
Can J Anesth, 53 (2006), pp. 305-315
[54.]
S. Nava, C. Gregoretti, F. Fanfulla, E. Squadrone, M. Grassi, A. Carlucci, et al.
Non-invasive ventilation to prevent respiratory failure after extubation in high-risk patients.
Crit Care Med, 33 (2005), pp. 2465-2470
[55.]
M. Ferrer, M. Valencia, J.M. Nicolás, O. Bernadich, J.R. Badia, A. Torres.
Early non-invasive ventilation averts extubation failure in patients at risk: a randomized trial.
Am J Resp Crit Care Med, 173 (2006), pp. 164-170
[56.]
D.J. Cook, S.D. Walter, R.J. Cook, L.E. Griffith, G.H. Guyatt, D. Leasa, et al.
Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients.
Ann Intern Med, 129 (1998), pp. 433-440
[57.]
E.H. Ibrahim, L. Tracy, C. Hill, V.J. Fraser, M.H. Kollef.
The occurrence of ventilator-associated pneumonia in a community hospital: risk factors and clinical outcomes.
Chest, 120 (2001), pp. 555-561
[58.]
H.M. Horst, D. Mouro, R.A. Hall-Jenssens, N. Pamukov.
Decrease in ventilation time with a standardized weaning process.
Arch Surg, 133 (1998), pp. 483-488
[59.]
M.H. Kollef, S.D. Shapiro, P. Silver, R.E. St John, D. Prentice, S. Sauer, et al.
A randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation.
Crit Care Med, 25 (1997), pp. 567-574
[60.]
P. Saura, L. Blanch, J. Mestre, J. Vallés, A. Artigas, R. Fernández.
Clinical consequences of the implementation of a weaning protocol.
Intensive Care Med, 22 (1996), pp. 1052-1056
[61.]
G. Wood, B. MacLeod, S. Moffatt.
Weaning from mechanical ventilation: physician-directed vs a respiratory-therapist-directed protocol.
Respir Care, 40 (1995), pp. 219-224
[62.]
D. Cook, M. Meade, G. Guyatt, L. Griffith, L. Booker.
Criteria for weaning from mechanical ventilation.
Evid Rep Technol Assess (Summ), (2000), pp. 1-4
[63.]
E.W. Ely, M.O. Meade, E.F. Haponik, M.H. Kollef, D.J. Cook, G.H. Guyatt, et al.
Mechanical ventilator weaning protocols driven by nonphysician health-care professionals: evidence-based clinical practice guidelines.
Chest, 120 (2001), pp. 454-463
[64.]
J.P. Kress, A.S. Pohlman, M.F. O’Connor, J.B. Hall.
Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation.
N Engl J Med, 342 (2000), pp. 1471-1477
[65.]
T.D. Girard, J.P. Kress, B.D. Fuchs, J.W. Thomason, W.D. Schweickert, B.T. Pun, et al.
Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial.
[66.]
B.E. Linden, E.A. Aguilar, S.J. Allen.
Sinusitis in the nasotracheally intubated patient.
Arch Otolaryngol Head Neck Surg, 114 (1988), pp. 860-861
[67.]
J.J. Rouby, P. Laurent, M. Gosnach, E. Cambau, G. Lamas, A. Zouaoui, et al.
Risk factors and clinical relevance of nosocomial maxillary sinusitis in the critically ill.
Am J Respir Crit Care Med, 150 (1994), pp. 776-783
[68.]
L. Holzapfel, S. Chevret, G. Madinier, F. Ohen, G. Demingeon, A. Coupry, et al.
Influence of long-term oro- or nasotracheal intubation on nosocomial maxillary sinusitis and pneumonia: results of a prospective, randomized, clinical trial.
Crit Care Med, 21 (1993), pp. 1132-1138
[69.]
F. Salord, P. Gaussorgues, J. Martí-Flich, M. Sirodot, C. Allimant, D. Lyonnet, et al.
Nosocomial maxillary sinusitis during mechanical ventilation: a prospective comparison of orotracheal versus the nasotracheal route for intubation.
Intensive Care Med, 16 (1990), pp. 390-393
[70.]
A. Michelson, H.D. Kamp, B. Schuster.
Sinusitis in long-term intubated, intensive care patients: nasal versus oral intubation.
Anaesthesist, 40 (1991), pp. 100-104
[71.]
L. Holzapfel.
Nasal vs oral intubation.
Minerva Anestesiol, 69 (2003), pp. 348-352
[72.]
L. Holzapfel, C. Chastang, G. Demingeon, J. Bohe, B. Piralla, A. Coupry.
A randomized study assessing the systematic search for maxillary sinusitis in nasotracheally mechanically ventilated patients. Influence of nosocomial maxillary sinusitis on the occurrence of ventilator-associated pneumonia.
Am J Respir Crit Care Med, 159 (1999), pp. 695-701
[73.]
A.R. Van Zanten, J.M. Dixon, M.D. Nipshagen, R. De Bree, A.R. Girbes, K.H. Polderman.
Hospital-acquired sinusitis is a common cause of fever of unknown origin in orotracheally intubated critically ill patients.
Crit Care, 9 (2005), pp. R583-R590
[74.]
F.D. Sottile, T.J. Marrie, D.S. Prough, C.D. Hobgood, D.J. Gower, L.X. Webb, et al.
Nosocomial pulmonary infection: possible etiologic significance of bacterial adhesion to endotracheal tubes.
Crit Care Med, 14 (1986), pp. 265-270
[75.]
C. Feldman, M. Kassel, J. Cantrell, S. Kaka, R. Morar, A. Goolam Mahomed, et al.
The presence and sequence of endotracheal tube colonization in patients undergoing mechanical ventilation.
Eur Respir J, 13 (1999), pp. 546-551
[76.]
C.G. Adair, S.P. Gorman, B.M. Feron, L.M. Byers, D.S. Jones, C.E. Goldsmith, et al.
Implications of endotracheal tube biofilm for ventilator-associated pneumonia.
Intensive Care Med, 25 (1999), pp. 1072-1076
[77.]
M.E. Rupp, T. Fitzgerald, N. Marion, V. Helget, S. Puumala, J.R. Anderson, et al.
Effect of silver-coated urinary catheters: efficacy, cost-effectiveness, and antimicrobial resistance.
Am J Infect Control, 32 (2004), pp. 445-450
[78.]
J. Rello, M. Kollef, E. Díaz, A. Sandiumenge, Y. Del Castillo, X. Corbella, et al.
Reduced burden of bacterial airway colonization with a novel silver-coated endotracheal tube in a randomized multiple-center feasibility study.
Crit Care Med, 34 (2006), pp. 2766-2772
[79.]
M.H. Kollef, B. Afessa, A. Anzueto, C. Veremakis, K.M. Kerr, B.D. Margolis, NASCENT Investigation Group, et al.
Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial.
JAMA, 300 (2008), pp. 805-813
[80.]
M.J. Bonten, M.H. Kollef, J.B. Hall.
Risk factors for ventilator-associated pneumonia: from epidemiology to patient management.
Clin Infect Dis, 38 (2004), pp. 1141-1149
[81.]
M. Valencia, M. Ferrer, R. Farré, D. Navajas, J.R. Badia, J.M. Nicolás, et al.
Automatic control of tracheal tube cuff pressure in ventilated patients in semirecumbent position: a randomized trial.
Crit Care Med, 35 (2007), pp. 1543-1549
[82.]
P. Mahul, C. Auboyer, R. Jospe, A. Ros, C. Guerin, Z. El Khouri, et al.
Prevention of nosocomial pneumonia in intubated patients: respective role of mechanical subglottic secretions drainage and stress ulcer prophylaxis.
Intensive Care Med, 18 (1992), pp. 20-25
[83.]
J. Valles, A. Artigas, J. Rello, N. Bonsoms, D. Fontanals, L. Blanch, et al.
Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia.
Ann Intern Med, 122 (1995), pp. 179-186
[84.]
K. Smulders, H. Van der Hoeven, I. Weers-Pothoff, C. Vandenbroucke-Grauls.
A randomized clinical trial of intermittent subglottic secretion drainage in patients receiving mechanical ventilation.
Chest, 121 (2002), pp. 858-862
[85.]
C. Dezfulian, K. Shojania, H.R. Collard, H.M. Kim, M.A. Matthay, S. Saint.
Subglottic secretion drainage for preventing ventilator-associated pneumonia: a meta-analysis.
[86.]
C.K. Dragoumanis, G.I. Vretzakis, V.E. Papaioannou, V.N. Didilis, T.D. Vogiatzaki, I.A. Pneumatikos.
Investigating the failure to aspirate subglottic secretions with the Evac endotracheal tube.
Anesth Analg, 105 (2007), pp. 1083-1085
[87.]
A. Dullenkopf, A. Gerber, M. Weiss.
Fluid leakage past tracheal tube cuffs: evaluation of the new Microcuff endotracheal tube.
Intensive Care Med, 29 (2003), pp. 1849-1853
[88.]
L. Lorente, M. Lecuona, A. Jiménez, M.L. Mora, A. Sierra.
Influence of an endotracheal tube with polyurethane cuff and subglottic secretion drainage on pneumonia.
Am J Respir Crit Care Med, 176 (2007), pp. 1079-1083
[89.]
E. Bouza, M.J. Pérez, P. Muñoz, C. Rincón, J.M. Barrio, J. Hortal.
Continuous aspiration of subglottic secretions in the prevention of ventilator-associated pneumonia in the postoperative period of major heart surgery.
Chest, 134 (2008), pp. 938-946
[90.]
G.T. Knowlson, H.F. Bassett.
The pressures exerted on the trachea by endotracheal inflatable cuffs.
Br J Anaesth, 42 (1970), pp. 834-837
[91.]
J.L. Stauffer, D.E. Olson, T.L. Petty.
Complications and consequences of endotracheal intubation and tracheotomy. A prospective study of 150 critically ill adult patients.
Am J Med, 70 (1981), pp. 65-76
[92.]
M. Orozco-Levi, A. Torres, M. Ferrer, C. Piera, M. El-Ebiary, J.P. De la Bellacasa, et al.
Semirecumbent position protects from pulmonary aspiration but not completely from gastroesophageal reflux in mechanically ventilated patients.
Am J Respir Crit Care Med, 152 (1995), pp. 1387-1390
[93.]
P. Sengupta, D.I. Sessler, P. Maglinger, S. Wells, A. Vogt, J. Durrani, et al.
Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure.
BMC Anesthesiol, 4 (2004), pp. 8
[94.]
L. Bunegin, M.S. Albin, R.B. Smith.
Canine tracheal blood flow after endotracheal tube cuff inflation during normotension and hypotension.
Anesth Analg, 76 (1993), pp. 1083-1090
[95.]
R.D. Seegobin, G.L. Van Hasselt.
Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs.
Br Med J (Clin Res Ed), 288 (1984), pp. 965-968
[96.]
J. Rello, R. Sonora, P. Jubert, A. Artigas, M. Rue, J. Valles.
Pneumonia in intubated patients: role of respiratory airway care.
Am J Resp Crit Care Med, 154 (1996), pp. 111-115
[97.]
R.D. Seegobin, G.L. Van Hasselt.
Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs.
Br Med J (Clin Res Ed), 288 (1984), pp. 965-968
[98.]
D.E. Craven, L.M. Kunches, V. Kilinsky, D.A. Lichtenberg, B.J. Make, W.R. McCabe.
Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation.
Am Rev Respir Dis, 133 (1986), pp. 792-796
[99.]
M.H. Kollef.
Ventilator-associated pneumonia. A multivariate analysis.
JAMA, 270 (1993), pp. 1965-1970
[100.]
D.E. Craven, K.A. Steger.
Epidemiology of nosocomial pneumonia. New perspectives on an old disease.
Chest, 108 (1995), pp. 1-16
[101.]
D.E. Craven, T.A. Goularte, B.J. Make.
Contaminated condensate in mechanical ventilator circuits. A risk factor for nosocomial pneumonia?.
Am Rev Respir Dis, 129 (1984), pp. 625-628
[102.]
D. Cook, B. De Jonghe, L. Brochard, C. Brun-Buisson.
Influence of airway management on ventilator-associated pneumonia: evidence from randomized trials.
JAMA, 279 (1998), pp. 781-787
[103.]
H.M. Babcock, J.E. Zack, T. Garrison, E. Trovillion, M. Jones, V.J. Fraser, et al.
An educational intervention to reduce ventilator-associated pneumonia in an integrated health system:a comparison of effects.
Chest, 125 (2004), pp. 2224-2231
[104.]
J.E. Zack, T. Garrison, E. Trovillion, D. Clinkscale, C.M. Coopersmith, V.J. Fraser, et al.
Effect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia.
Crit Care Med, 30 (2002), pp. 2407-2412
[105.]
M.H. Kollef, S.D. Shapiro, V. Boyd, P. Silver, B. Von Harz, E. Trovillion, et al.
A randomized clinical trial comparing an extended-use hygroscopic condenser humidifier with heated-water humidification in mechanically ventilated patients.
Chest, 113 (1998), pp. 759-767
[106.]
P. Markowicz, J.D. Ricard, D. Dreyfuss, L. Mier, P. Brun, F. Coste, et al.
Safety, efficacy, and cost-effectiveness of mechanical ventilation with humidifying filters changed every 48 hours: a prospective, randomized study.
Crit Care Med, 28 (2000), pp. 665-671
[107.]
A. Torres, J. Serra-Batllés, E. Ros, C. Piera, J. Puig de la Bellacasa, A. Cobos, et al.
Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: the effect of body position.
Ann Intern Med, 116 (1992), pp. 540-543
[108.]
J. Ibáñez, A. Peñafiel, J.M. Raurich, P. Marsé, R. Jordá, F. Mata.
Gastroesophageal reflux in intubated patients receiving enteral nutrition: effect of supine and semirecumbent positions.
J Parenter Enteral Nutr, 16 (1992), pp. 419-422
[109.]
E.J. Huxley, J. Viroslav, W.R. Gray, A.K. Pierce.
Pharyngeal aspiration in normal adults and patients with depressed consciousness.
Am J Med, 64 (1978), pp. 564-568
[110.]
M.B. Drakulovic, A. Torres, T.T. Bauer, J.M. Nicolás, S. Nogué, M. Ferrer.
Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial.
Lancet, 354 (1999), pp. 1851-1858
[111.]
M.H. Kollef.
Ventilator-associated pneumonia. A multivariate analysis.
JAMA, 270 (1993), pp. 1965-1970
[112.]
C.A. Van Nieuwenhoven, C. Vandenbroucke-Grauls, F.H. Van Tiel, H.C. Joore, R.J. Van Schijndel, I. Van der Tweel, et al.
Feasibility and effects of the semirecumbent position to prevent ventilator-associated pneumonia: a randomized study.
Crit Care Med, 34 (2006), pp. 396-402
[113.]
L.D. Nelson, S.C. Choi.
Kinetic therapy in critically ill trauma patients.
Clin Intensive Care, 3 (1992), pp. 248-252
[114.]
G.A. Traver, M.L. Tyler, L.D. Hudson, D.L. Sherrill, S.F. Quan.
Continuous oscillation: outcome in critically ill patients.
J Crit Care, 10 (1995), pp. 97-103
[115.]
M. Giner, A. Laviano, M.M. Meguid, J.R. Gleason.
In 1995 a correlation between malnutrition and poor outcome in critically ill patients still exists.
Nutrition, 12 (1996), pp. 23-29
[116.]
L.C. Smith, J.L. Mullen.
Nutritional assessment and indications for nutritional support.
Surg Clin North Am, 71 (1991), pp. 449-457
[17.]
V. Artinian, H. Krayem, B. DiGiovine.
Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients.
Chest, 29 (2006), pp. 960-967
[118.]
D. Cook, B.D. Jonghe, D. Heyland.
The relation between nutrition and nosocomial pneumonia: randomized trials in critically ill patients.
Crit Care, 1 (1997), pp. 3-9
[119.]
S.K. Pingleton, D.R. Hinthorn, C. Liu.
Enteral nutrition in patients receiving mechanical ventilation. Multiple sources of tracheal colonization include the stomach.
Am J Med, 80 (1986), pp. 827-832
[120.]
H. Mentec, H. Dupont, M. Bocchetti, P. Cani, F. Ponche, G. Bleichner.
Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors, and complications.
Crit Care Med, 29 (2001), pp. 1955-1961
[121.]
A. Bowman, J.E. Greiner, K.C. Doerschug, S.B. Little, C.L. Bombei, L.M. Comried.
Implementation of an evidence-based feeding protocol and aspiration risk reduction algorithm.
Crit Care Nurs Q, 28 (2005), pp. 324-335
[122.]
L. Gramlich, K. Kichian, J. Pinilla, N.J. Rodych, R. Dhaliwal, D.K. Heyland.
Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature.
Nutrition, 20 (2004), pp. 843-848
[123.]
D.K. Heyland, R. Dhaliwal, J.W. Drover.
Nutrition support in mechanically ventilated, critically ill adult patients:are we ready for evidence-based clinical practice guidelines?.
Nutr Clin Pract, 19 (2004), pp. 193-200
[124.]
K.M. Ho, G.J. Dobb, S.A. Webb.
A comparison of early gastric and post-pyloric feeding in critically ill patients:a meta-analysis.
Intensive Care Med, 32 (2006), pp. 639-649
Copyright © 2010. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?