A Randomized Study Assessing the Systematic Search for Maxillary Sinusitis in Nasotracheally Mechanically Ventilated Patients

Holzapfel, L.; Chastang, Claude; Demingeon, G.; Bohé, Julien; Piralla, B.; Coupry, A.

doi:10.1164/ajrccm.159.3.9712076

Cited by 197 publications

(90 citation statements)

References 21 publications

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“…A standard treatment protocol was used to ensure that no known confounding factors would influence the difference in frequency of VAP between the two study groups. Specifically, all participants were orally intubated [13], placed in a 30-45˚semi-recumbent position [14] and received the same antibiotic and H2 receptor antagonists treatment regimen [25,26].…”

Section: Discussionmentioning

confidence: 99%

“…Patients were orally intubated [13], placed on the ICU bed in a semi-recumbent position (30-45˚) [14] and tracheostomy was not performed until completion of 3 weeks of MV. No closed circuits for tracheal suctioning were used [15].…”

Section: Subjectsmentioning

confidence: 99%

“…For this reason, similar disease severity between the study groups was ensured not only by comparing APACHE II scores, but also by using a Glasgow Coma Score of ,6 as an entry criterion. A diagnosis of sinusitis by computed tomography scan was also noted [13]. If there was a suspicion of pneumonia during participation in the study, flexible bronchoscopy and bronchoalveolar lavage (BAL) were performed and BAL samples were sent for quantitative cultures.…”

Section: Subjectsmentioning

confidence: 99%

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Early gastrostomy reduces the rate of ventilator-associated pneumonia in stroke or head injury patients

Kostadima

Kaditis²,

Alexopoulos³

et al. 2005

European Respiratory Journal

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Presence of a nasogastric tube is a risk factor for the development of ventilatorassociated pneumonia (VAP). Alternatively, gastrostomy can be used for administration of enteral feedings.To determine whether early performance of gastrostomy affects frequency of VAP, a randomised, controlled study was carried out in patients mechanically ventilated for stroke or head injury. In the gastrostomy group, patients underwent the procedure within 24 h of intubation. A nasogastric tube was inserted in controls. Individual subjects were studied for 3 weeks.In total, 20 subjects (mean age 48¡15.2 yrs) were allocated to the gastrostomy group, and 21 to the control group (46.6¡15.4 yrs). Of these groups, two (10%) and eight (38.1%) developed VAP, respectively. Four patients with gastrostomy and three controls did not complete the study (due to weaning from ventilatory support or death). After excluding these subjects, difference in VAP frequency persisted: two out of 16 subjects with gastrostomy had VAP (12.5%) versus eight out of 18 controls (44.4%). There were no differences in duration of hospitalisation or mortality between the two groups.In conclusion, in patients mechanically ventilated for stroke or head injury early gastrostomy is associated with a lower frequency of ventilator-associated pneumonia compared with a nasogastric tube.

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Section: Discussionmentioning

confidence: 99%

Section: Subjectsmentioning

confidence: 99%

Section: Subjectsmentioning

confidence: 99%

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Early gastrostomy reduces the rate of ventilator-associated pneumonia in stroke or head injury patients

Kostadima

Kaditis²,

Alexopoulos³

et al. 2005

European Respiratory Journal

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“…Orotracheal and orogastric intubation have been associated with reduced incidences of VAP and nosocomial sinusitis [49,50]. Therefore, the oral route is preferred when intubation of the trachea and esophagus is necessary in a critically ill patient.…”

Section: Prevention Of Nosocomial Pneumonia 213mentioning

confidence: 99%

Prevention of Nosocomial Pneumonia in the Intensive Care Unit: Beyond the Use of Bundles

Kollef

2011

Surgical Infections

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Background: The occurrence of nosocomial pneumonia (NP) in the hospital setting is especially problematic, as it is associated with a greater risk of in-hospital death, longer stays on mechanical ventilation and in the intensive care unit (ICU), more need for tracheostomy, and significantly higher medical care costs. Methods: Review of the pertinent English-language literature. Results: The adverse effect of NP on healthcare outcomes has increased pressure on clinicians and hospital systems to prevent this infection. This brief review provides an overview of the current approaches to the prevention of NP, focusing primarily on ventilator-associated pneumonia (VAP). Conclusion: Clinicians working in ICUs should consider the following recommendations: (1) Develop a VAP prevention bundle based on evidence-based guidelines; (2) monitor the rates of VAP prior to and during implementation of the program; (3) make adjustments according to VAP occurrence; and (4) integrate VAP prevention with other quality improvement programs.

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“…La intubación naso-traqueal no está exenta de esta situación, más aún, ésta se asocia a mayor incidencia de sinusitis 41,42 y ésta a su vez podría aumentar el riesgo de NAVM 41,43 . Un estudio controlado con un grupo de pacientes intubado por vía naso-traqueal y otro por vía oro-traqueal encontró en el análisis multivariado que la sinusitis es un factor que aumenta en 3,8 veces la frecuencia de NAVM 42 .…”

Section: La Higiene Rutinaria De La Cavidad Oral ¿Es De Utilidad Paraunclassified

Actualización Consenso Neumonía asociada a ventilación mecánica: Segunda parte. Prevención

Chacón

et al. 2011

Rev. chil. infectol.

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Update. Consensus on Ventilator Associated Pneumonia.Second Part: ProphylaxisVentilator associated pneumonia is a life threatening disease, in spite of advances in its treatment, consequently the development of prevention strategies is a key factor in improving the morbidity and mortality in intensive care units (ICU). The new developments in this fi eld in the last years led to the need to update the recommendations done in 2001. Then, a new search and analysis of scientifi c literature was performed. The obtained data support different strategies highlighting: semi-recumbent position at 45° of patients; incorporation of routinely oral hygiene procedures with chlorhexidine; preference of orotracheal intubation; performing subglotic aspiration; use of standard hand hygiene techniques; not routine change of ventilator circuits; and defi ning bundles to organize the work at ICU. Some strategies were recommended for being of similar effi cacy to others but cost-effective as: use of heat and moisture humidifi cators; and changing humidifi cators every 5 to 7 days. The use of open or closed endotracheal suctioning system does not affect the incidence of pneumonia. Some recommendations were not incorporated because of lack of evidence supporting effectiveness, controversial data or doubtful application to our country as selective digestive decontamination.Key words: Prevention, ventilator-associated pneumonia, guidelines, mechanical ventilation, consensus. Palabras clave: Prevención, neumonía asociada a ventilación mecánica, guías clínicas, ventilación mecánica, consenso. Universidad Austral de Chile, Valdivia (MCA).Hospital San Borja Arriarán, Santiago (LDM).Hospital Padre Hurtado, Santiago. Enfermera Control de IAAS (ECV).Hospital Clínico Universidad IntroducciónL a neumonía asociada a ventilación mecánica (NAVM) se mantiene como una entidad de alta mortalidad que afecta a las poblaciones sometidas a este procedimiento. A pesar de que se han diseñado estrategias para iniciar un tratamiento oportuno y apropiado, mejorando el pronóstico de mortalidad de los enfermos, no es menos cierto que la mortalidad atribuible es aún elevada con una terapia adecuada. Por esto, el desarrollo y ejecución de medidas de prevención adecuadas parece ser uno de los esfuerzos más acertados para la disminución de la morbi-mortalidad asociada a este cuadro.En los últimos nueve años, el desarrollo de la literatura científi ca enfocada a este aspecto ha sido enorme y muy variado, incluyendo nuevos tipos de intervenciones, a la vez que ha intentado esclarecer la utilidad de las más antiguas; por otro lado, en otras se ha logrado tener un mejor dato respecto a su evidencia, así como en algunas, por el poco tiempo de desarrollo que llevan, no ha sido posible dar una recomendación con la misma calidad de fundamento.Como se ha mencionado previamente, este artículo es parte de la actualización del consenso realizado, con anterioridad, por la Sociedad Chilena de Infectología en el año 2001. La metodología nuevamente ha buscado realizar recomendacio...

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A Randomized Study Assessing the Systematic Search for Maxillary Sinusitis in Nasotracheally Mechanically Ventilated Patients

Cited by 197 publications

References 21 publications

Early gastrostomy reduces the rate of ventilator-associated pneumonia in stroke or head injury patients

Early gastrostomy reduces the rate of ventilator-associated pneumonia in stroke or head injury patients

Prevention of Nosocomial Pneumonia in the Intensive Care Unit: Beyond the Use of Bundles

Actualización Consenso Neumonía asociada a ventilación mecánica: Segunda parte. Prevención

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