Sedation, Sucralfate, and Antibiotic Use Are Potential Means for Protection against Early-Onset Ventilator-Associated Pneumonia

Bornstain, Caroline; Azoulay, Élie; Lassence, Arnaud de; Cohen, Yves; Costa, Marie-Alyette; Mourvillier, Bruno; Descorps-Declère, A.; Garrouste-Orgeas, Maïté; Thuong, Marie; Schlemmer, Benoı̂t; Timsit, Jean François

doi:10.1086/386321

Cited by 60 publications

(36 citation statements)

References 50 publications

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“…Previous studies [10,31] have found a significant association between coma and VAP. This association may be related to the frequent aspiration in patients with neurological impairment.…”

Section: S Aureusmentioning

confidence: 81%

Relationship between tracheotomy and ventilator-associated pneumonia: a case control study

Nseir

Pompéo²,

Jozefowicz³

et al. 2007

European Respiratory Journal

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The aim of the present study was to determine the relationship between tracheotomy and ventilator-associated pneumonia (VAP).The study used a retrospective case-control study design based on prospective data. All nontrauma immunocompetent patients, intubated and ventilated for .7 days, were eligible for inclusion in the study. A diagnosis of VAP was based on clinical, radiographical and microbiological criteria. Four matching criteria were used, including duration of mechanical ventilation (MV). The indication and timing of tracheotomy were at the discretion of attending physicians. Univariate and multivariate analyses were performed to determine risk factors for VAP in cases (patients with tracheotomy) and controls (patients without tracheotomy).In total, 1,402 patients were eligible for inclusion. Surgical tracheotomy was performed in 226 (16%) patients and matching was successful for 177 (78%). The rate of VAP (22 versus 14 VAP episodes?1,000 MV-days -1 ) was significantly higher in controls than in cases. The rate of VAP after tracheotomy in cases, or after the corresponding day of MV in controls, was also significantly higher in control than in case patients (9.2 versus 4.8 VAP episodes?1,000 MV-days -1). In multivariate analysis, neurological failure (odds ratio (95% confidence interval) 2.7 (1.3-5)), antibiotic treatment (2.1 (1.1-3.2)) and tracheotomy (0.18 (0.1-0.3)) were associated with VAP.In summary, the present study demonstrates that tracheotomy is independently associated with decreased risk for ventilator-associated pneumonia.KEYWORDS: Intensive care, nosocomial pneumonia, risk factors, tracheostomy, tracheotomy, ventilator-associated pneumonia V entilator-associated pneumonia (VAP) occurs in a considerable proportion of patients undergoing mechanical ventilation and is associated with substantial morbidity, two-fold mortality rate and excess cost [1]. Strategies that effectively prevent VAP are needed. Identifying modifiable risk factors for VAP could be helpful for future controlled interventional studies aiming at improving prevention of VAP [2].Short-term tracheotomy is frequently performed in intensive care unit (ICU) patients with weaning difficulties or predicted long periods of mechanical ventilation (MV). According to the results of two recent studies performed on .40,000 patients, 7.7-10.7% of ICU patients receive invasive MV through a tracheotomy cannula during their ICU stay [3,4].Recent studies reported high VAP rates after surgical and percutaneous tracheotomy (25 and 18%, respectively) [5,6]. In these studies, most VAP episodes occurred in the week following the procedure. Unfortunately, the incidence of VAP after tracheotomy was not compared with VAP incidence before tracheotomy, or with VAP incidence in patients without tracheotomy. Several recent studies identified tracheotomy as an independent risk factor for VAP [7][8][9][10]. However, only one study excluded tracheotomy from risk factor analysis when it was performed after VAP occurrence [8]. In addition, none of th...

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“…Previous studies [10,31] have found a significant association between coma and VAP. This association may be related to the frequent aspiration in patients with neurological impairment.…”

Section: S Aureusmentioning

confidence: 81%

Relationship between tracheotomy and ventilator-associated pneumonia: a case control study

Nseir

Pompéo²,

Jozefowicz³

et al. 2007

European Respiratory Journal

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“…This disease leads to increase of mortality in patients, duration of hospitalization and therapeutic costs [9,10]. Rate of appearance of pneumonia caused by ventilator has been reported in a range from 7.5% to 45% in the various studies [11][12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Determination of Frequency of Bacterial Agent Causing Ventilator Associated Pneumonia in the Patients Hospitalized in the Intensive Care Unit of Tonkabon Shahid Rajaei Hospital by PCR Sequencing

Ghafari

Ghane

2017

Zahedan J Res Med Sci

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Background: Ventilator associated pneumonia (VAP) is the most prevalent hospitalized infection in the intensive care unit (ICU) causing increase of the therapeutic costs and mortality. Objectives: The purpose of this study is to determine the bacterial agents causing VAP in the patients hospitalized in the ICU of Tonekabon Shahid Rajaei hospital. Methods: From April to March of 2015, out of 35 patients hospitalized in ICU of Tonekabon Shahid Rajaei hospital and infected with VAP, sampling was carried out from splint pipe, and the samples, following the transfer to the transport culture medium, were transferred to laboratory and incubated in 37°C for 72 hours. In order to isolate the bacteria, the standard culture technique was used for assistance. After appearance of colony on the blood agar medium, DNA extraction was enforced by use of phenol-chloroform technique, and identification of the bacterium was accomplished using sequencing PCR technique. Results: A total of 35patients, 16 patients (45.7%) are women and 19 patients (54.3%) are men, and age range of the patients is from 15 to 88 years. totally, 53 bacteria were isolated out of which 28 bacteria (52.8%) were Gram-positive and 25 bacteria (47.2%) were Gramnegative. In the present study, the most prevalent identified bacterial agents included bacteria belonging to family of Enterobacteriaceae (35.4%), Staphylococcus aureus (20.7%), other species of Staphylococcus (14.7%), Pseudomonas aeruginosa (11.3%), Acinetobacter bumani (9.4%) and Corynebacterium (7.5%). 7 individuals (20%) of the patients with pneumonia resulted from ventilator were died. Conclusions:The obtained findings showed that various factors play a role in the occurrence of VAP. Cause if difference in the outbreak of VAP in the ICU is due to difference in type of disease, accompaniment of the various susceptible-making factors in their background diseases. Therefore, observance of infection control standards to prevent form VAP is advised.

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“…The database is specifically designed to record daily disease severity and the occurrence of iatrogenic events and nosocomial infections [1,[17][18][19][20][21]. Inclusion criteria for the study were MV for o2 days, started within 48 h after ICU admission, with an arterial oxygen tension/inspiratory oxygen fraction ratio (Pa,O 2 /FI,O 2 ) f300 during the first 2 days of MV with bilateral infiltrates with classic absence of clinical evidence of left atrial hypertension according to the protocol of each ICU.…”

Section: Study Design and Data Sourcementioning

confidence: 99%

“…MV duration, time in the ICU and hospital, and outcome at ICU and hospital discharge were recorded prospectively. Clinically suspected nosocomial pneumonia was routinely investigated using cultures of protected distal specimens, protected brushing or bronchoalveolar lavage, as previously described [2,18].…”

Section: Data Collectionmentioning

confidence: 99%

Study of prone positioning to reduce ventilator-associated pneumonia in hypoxaemic patients

Mounier

Adrie²,

Français³

et al. 2009

European Respiratory Journal

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The aim of the present study was to examine whether prone positioning (PP) affects ventilator associated-pneumonia (VAP) and mortality in patients with acute lung injury/adult respiratory distress syndrome.2,409 prospectively included patients were admitted over 9 yrs (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008) to 12 French intensive care units (ICUs) (OUTCOMEREA). The patients required invasive mechanical ventilation (MV) and had arterial oxygen tension/inspiratory oxygen fraction ratios ,300 during the first 48 h. Controls were matched to PP patients on the PP propensity score (¡10%), MV duration longer than that in PP patients before the first turn prone, and centre.VAP incidence was similar in the PP and control groups (24 versus 13 episodes?1,000 patientdays MV -1 respectively, p50.14). After adjustment, PP did not decrease VAP occurrence (HR 1.64(95% CI 0.70-3.84); p50.25) but significantly delayed hospital mortality (HR 0.56 (95% CI 0.39-0.79); p50.001), without decreasing 28-day mortality (37% in both groups). Post hoc analyses indicated that PP did not protect against VAP but, when used for .1 day, might decrease mortality and benefit the sickest patients (Simplified Acute Physiology Score .50).In ICU patients with hypoxaemic acute respiratory failure, PP had no effect on the risk of VAP. PP delayed mortality without decreasing 28-day mortality. PP .1 day might decrease mortality, particularly in the sickest patients.

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Sedation, Sucralfate, and Antibiotic Use Are Potential Means for Protection against Early-Onset Ventilator-Associated Pneumonia

Cited by 60 publications

References 50 publications

Relationship between tracheotomy and ventilator-associated pneumonia: a case control study

Relationship between tracheotomy and ventilator-associated pneumonia: a case control study

Determination of Frequency of Bacterial Agent Causing Ventilator Associated Pneumonia in the Patients Hospitalized in the Intensive Care Unit of Tonkabon Shahid Rajaei Hospital by PCR Sequencing

Study of prone positioning to reduce ventilator-associated pneumonia in hypoxaemic patients

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