Issue

Vol. 1 No. 1 (2024)

Date Log

Submitted
September 21, 2025
Published
December 31, 2024

Copyright (c) 2024 Jassim Mohammed  Al Essa, Zahrah Essa   Alabbas, Bibi Ahmad   Alhamoud, Zahra Abdullah Ali   Alaskari, Fatimah Mohammad Thuaimer, Afnan Ahmad   Alnigie, Amirah Hassan Amer   Asiri, Dalal Suliman Mohd   Asiri, Elham Hussain Sharaf Altaha, Khaled Alnashmi F Alanazi

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

The Role Of Respiratory Therapists And Nursing In Reducing And Preventing Of Ventilator-Associated Pneumonia

https://doi.org/10.64483/20251144
Jassim Mohammed  Al Essa
Ministry Of Health, Maternity and children Hospital , Saudi Arabia
Zahrah Essa   Alabbas
Ministry Of Health, PHC SAIHAT 1 , Saudi Arabia
Bibi Ahmad   Alhamoud
Ministry Of Health, PHC SAIHAT 1 , Saudi Arabia
Zahra Abdullah Ali   Alaskari
Ministry Of Health, MCH DAMMAM, Saudi Arabia
Fatimah Mohammad Thuaimer
Ministry Of Health, Maternity and Children Hospital, Saudi Arabia
Afnan Ahmad   Alnigie
Ministry Of Health, Al wadyain PHC, Saudi Arabia
Amirah Hassan Amer   Asiri
Ministry Of Health,Altahaheen PHCC, Saudi Arabia
Dalal Suliman Mohd   Asiri
Ministry Of Health, Altahaheen PHCC, Saudi Arabia
Elham Hussain Sharaf Altaha
Ministry Of Health, Al-Fudul Health Center, Saudi Arabia
Khaled Alnashmi F Alanazi
Ministry Of Health, MOH-Riyadh Second Health Cluster, Saudi Arabia

Corresponding Author(s) : Jassim Mohammed  Al Essa

Jmae.2013@gmail.com

Saudi Journal of Medicine and Public Health, Vol. 1 No. 1 (2024)

Abstract

Background: Ventilator-associated pneumonia (VAP) comprises ~50% of nosocomial pneumonias and remains the most frequent infection among mechanically ventilated patients, driving mortality, prolonged ICU/hospital length of stay, antimicrobial exposure, and costs. Diagnostic ambiguity, shifting CDC definitions to ventilator-associated events (VAEs), and the SARS-CoV-2 era have complicated surveillance and benchmarking.


Aim: To synthesize practical, evidence-based strategies—especially those enacted by respiratory therapists (RTs) and nursing—to reduce VAP incidence and improve patient-centered outcomes.


Methods: Narrative integration of randomized trials, meta-analyses, and prospective cohorts cited in the source text, emphasizing core bundle elements (head-of-bed elevation, daily sedation interruption, spontaneous breathing trials), early mobilization, oral care/decontamination options, circuit stewardship, subglottic drainage, and implementation science.


Results: Highest-yield measures shorten ventilator exposure and curb aspiration: semirecumbency (30°–45°), light/goal-directed sedation with daily awakening and synchronized SBTs, and early mobilization improve ventilator-free days and functional outcomes. Oral chlorhexidine reduces VAP chiefly in short-stay cardiac cohorts; signals of harm in general ICUs warrant caution. Subglottic drainage lowers early VAP, particularly within comprehensive bundles. Probiotics lack benefit. Compliance, education, and feedback loops determine real-world effectiveness.


Conclusion: RT- and nursing-led, implementation-ready bundles that minimize ventilation days and aspiration—augmented by targeted technologies and antimicrobial stewardship—can meaningfully attenuate VAP while preserving resources.

Al Essa, J. M., Alabbas,Z.E. , Alhamoud,B.A. , Alaskari,Z.A.A. , Thuaimer, F. M., Alnigie,A.A. , … Alanazi, K. A. F. (2024). The Role Of Respiratory Therapists And Nursing In Reducing And Preventing Of Ventilator-Associated Pneumonia. Saudi Journal of Medicine and Public Health, 1(1), 315–335. https://doi.org/10.64483/20251144
Download Citation
Endnote/Zotero/Mendeley (RIS)
BibTeX
References
  1. Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63:e61–e111.
  2. Torres A, Niederman MS, Chastre J, et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired and ventilator-associated pneumonia. Eur Respir J. 2017;50:1700582.
  3. Vincent JL, Sakr Y, Singer M, et al. Prevalence and outcomes of infection among patients in intensive care units in 2017. JAMA. 2020;323:1478–1487.
  4. Melsen WG, Rovers MM, Groenwold RHH, et al. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis. 2013;13:665–671.
  5. Kollef MH, Hamilton CW, Ernst FR. Economic impact of ventilator-associated pneumonia in a large matched cohort. Infect Control Hosp Epidemiol. 2012;33:250–256.
  6. Klompas M, Branson R, Eichenwald EC, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35:915–936.
  7. Wunderink RG, Woldenberg LS, Zeiss J, et al. The radiologic diagnosis of autopsy-proven ventilator-associated pneumonia. Chest. 1992;101:458–463.
  8. Klompas M. Interobserver variability in ventilator-associated pneumonia surveillance. Am J Infect Control. 2010;38:237–239.
  9. Dudeck MA, Weiner LM, Allen-Bridson K, et al. National Healthcare Safety Network (NHSN) report, data summary for 2012, device-associated module. Am J Infect Control. 2013;41:1148–1166.
  10. Rosenthal VD, Al-Abdely HM, El-Kholy AA, et al. International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010–2015: device-associated module. Am J Infect Control. 2016;44:1495–1504.
  11. Kollef MH, Chastre J, Fagon J-Y, et al. Global prospective epidemiologic and surveillance study of ventilator-associated pneumonia due to Pseudomonas aeruginosa. Crit Care Med. 2014;42:2178–2187.
  12. Skrupky LP, McConnell K, Dallas J, et al. A comparison of ventilator-associated pneumonia rates as identified according to the National Healthcare Safety Network and American College of Chest Physicians criteria. Crit Care Med. 2012;40:281–284.
  13. Magill SS, Klompas M, Balk R, et al. Developing a new, national approach to surveillance for ventilator-associated events: executive summary. Clin Infect Dis. 2013;57:1742–1746.
  14. Kobayashi H, Uchino S, Takinami M, et al. The impact of ventilator-associated events in critically ill subjects with prolonged mechanical ventilation. Respir Care. 2017;62:1379–1386.
  15. Fan Y, Gao F, Wu Y, et al. Does ventilator-associated event surveillance detect ventilator-associated pneumonia in intensive care units? A systematic review and meta-analysis. Crit Care. 2016;20:338.
  16. Bergin SP, Coles A, Calvert SB, et al. PROPHETIC: prospective identification of pneumonia in hospitalized patients in the ICU. Chest. 2020;158:2370–2380.
  17. Bergin SP, Calvert SB, Farley J, et al. PROPHETIC EU: prospective identification of pneumonia in hospitalized patients in the ICU in European and United States cohorts. Open Forum Infect Dis. 2022;9:ofac231.
  18. Centers for Disease Control and Prevention (CDC). COVID-19: U.S. impact on antimicrobial resistance—special report 2022. Atlanta (GA): U.S. Department of Health and Human Services, CDC; 2022. Available from: https://www.cdc.gov/drugresistance/covid19.html (accessed 2023 Jun 19).
  19. Vacheron C-H, Lepape A, Savey A, et al. Attributable mortality of ventilator-associated pneumonia among patients with COVID-19. Am J Respir Crit Care Med. 2022;206:161–169.
  20. Pickens CO, Gao CA, Cuttica MJ, et al.; NU COVID Investigators. Bacterial superinfection pneumonia in patients mechanically ventilated for COVID-19 pneumonia. Am J Respir Crit Care Med. 2021;204:921–932.
  21. Metersky ML, Wang Y, Klompas M, et al. Trend in ventilator-associated pneumonia rates between 2005 and 2013. JAMA. 2016;316:2427–2429.
  22. Zilberberg MD, Nathanson BH, Puzniak LA, et al. Descriptive epidemiology and outcomes of nonventilated hospital-acquired, ventilated hospital-acquired, and ventilator-associated bacterial pneumonia in the United States, 2012–2019. Crit Care Med. 2022;50:460–468.
  23. Motowski H, Ilges D, Hampton N, et al. Determinants of mortality for ventilated hospital-acquired pneumonia and ventilator-associated pneumonia. Crit Care Explor. 2023;5:e0867.
  24. Bekaert M, Timsit JF, Vansteelandt S, et al. Attributable mortality of ventilator-associated pneumonia: a reappraisal using causal analysis. Am J Respir Crit Care Med. 2011;184:1133–1139.
  25. Nguile-Makao M, Zahar J-R, Français A, et al. Attributable mortality of ventilator-associated pneumonia: respective impact of main characteristics at ICU admission and VAP onset using conditional logistic regression and multi-state models. Intensive Care Med. 2010;36:781–789.
  26. Kollef MH. Ventilator-associated pneumonia prevention. Is it worth it? Am J Respir Crit Care Med. 2015;192:5–7.
  27. Botlet E, Yakusheva O, Costa DK. Nursing strategies to prevent ventilator-associated pneumonia. Am Nurse Today. 2017;12:42–43.
  28. Kollef MH, Sherman G, Ward S, et al. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest. 1999;115:462–474.
  29. Iregi M, Ward S, Sherman G, et al. Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia. Chest. 2002;122:262–268.
  30. Torres A, Serra-Batlles J, Ros E, et al. Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: the effect of body position. Ann Intern Med. 1992;116:540–543.
  31. Garrouste-Orgeas M, Chevret S, Arlet G, et al. Oropharyngeal or gastric colonization and nosocomial pneumonia in adult intensive care unit patients: a prospective study based on genomic DNA analysis. Am J Respir Crit Care Med. 1997;156:1647–1655.
  32. Bonten MJ, Gaillard CA, van Tiel FH, et al. The stomach is not a source for colonization of the upper respiratory tract and pneumonia in ICU patients. Chest. 1994;105:878–884.
  33. Drakulovic MB, Torres A, Bauer TT, et al. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet. 1999;354:1851–1858.
  34. van Nieuwenhoven CA, Vandenbroucke-Grauls C, van Tiel FH, et al. Feasibility and effects of the semirecumbent position to prevent ventilator-associated pneumonia: a randomized study. Crit Care Med. 2006;34:396–402.
  35. Williams Z, Chan R, Kelly E. A simple device to increase rates of compliance in maintaining 30-degree head-of-bed elevation in ventilated patients. Crit Care Med. 2008;36:1155–1157.
  36. Wolken RF, Woodruff RJ, Smith J, et al. Observational study of head of bed elevation adherence using a continuous monitoring system in a medical intensive care unit. Respir Care. 2012;57:537–543.
  37. Wang L, Li X, Yang Z, et al. Semi-recumbent position versus supine position for the prevention of ventilator-associated pneumonia in adults requiring mechanical ventilation. Cochrane Database Syst Rev. 2016;CD009946.
  38. Klompas M, Li L, Kleinman K, et al. Associations between ventilator bundle components and outcomes. JAMA Intern Med. 2016;176:1277–1283.
  39. Li Bassi G, Panigada M, Ranzani OT, et al. Randomized, multicenter trial of lateral Trendelenburg versus semirecumbent body position for the prevention of ventilator-associated pneumonia. Intensive Care Med. 2017;43:1572–1584.
  40. Zhu X, Lu Z, Xiao W, et al. The effect of prone position for ventilator-associated pneumonia in adult patients: a systematic review and meta-analysis. Emerg Crit Care Med. 2021;1:37–44.
  41. Agency for Healthcare Research and Quality (AHRQ). Head of bed elevation or semirecumbent positioning literature review. Rockville (MD): AHRQ; 2017 Jan. Available from: https://www.ahrq.gov/hai/tools/mvp/modules/technical/head-bed-elevation-lit-review.html (accessed 2023 Jun 20).
  42. Kress JP, Pohlman AS, O’Connor MF, et al. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000;342:1471–1477.
  43. Strøm T, Martinussen T, Toft P. A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet. 2010;375:475–480.
  44. Girard TD, Kress JP, Fuchs BD, 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. Lancet. 2008;371:126–134.
  45. Mehta S, Burry L, Cook D, et al. Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: a randomized controlled trial. JAMA. 2012;308:1985–1992.
  46. Balas MC, Tan A, Mion LC, et al. Factors associated with spontaneous awakening trial and spontaneous breathing trial performance in adults with critical illness: analysis of a multicenter, nationwide, cohort study. Chest. 2022;162:588–602.
  47. Moraes FDS, Marengo LL, Moura MDG, et al. ABCDE and ABCDEF care bundles: a systematic review of the implementation process in intensive care units. Medicine (Baltimore). 2022;101:e29499.
  48. Ely EW, Baker AM, Dunagan DP, et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med. 1996;335:1864–1869.
  49. Kollef MH, Shapiro SD, Silver P, et al. A randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation. Crit Care Med. 1997;25:567–574.
  50. Lellouche F, Mancebo J, Jolliet P, et al. A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation. Am J Respir Crit Care Med. 2006;174:894–900.
  51. Blackwood B, Burns KEA, Cardwell CR, et al. Protocolized versus non-protocolized weaning for reducing the duration of mechanical ventilation in critically ill adult patients. Cochrane Database Syst Rev. 2014;CD006904.
  52. Thille AW, Gacouin A, Coudroy R, et al. Spontaneous-breathing trials with pressure-support ventilation or a T-piece. N Engl J Med. 2022;387:1843–18.
  53. Pohlman MC, Schweickert WD, Pohlman AS, et al. Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation. Crit Care Med. 2010;38:2089–2094.
  54. Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373:1874–1882.
  55. Patel BK, Wolfe KS, Patel SB, et al. Effect of early mobilisation on long-term cognitive impairment in critical illness in the USA: a randomised controlled trial. Lancet Respir Med. 2023;11:563–572.
  56. Su K-C, Kou YR, Lin F-C, et al. A simplified prevention bundle with dual hand hygiene audit reduces early-onset ventilator-associated pneumonia in cardiovascular surgery units: an interrupted time-series analysis. PLoS One. 2017;12:e0182252.
  57. Rello J, Afonso E, Lisboa T, et al. A care bundle approach for prevention of ventilator-associated pneumonia. Clin Microbiol Infect. 2013;19:363–369.
  58. Koff MD, Corwin HL, Beah ML, et al. Reduction in ventilator associated pneumonia in a mixed intensive care unit after initiation of a novel hand hygiene program. Crit Care. 2011;26:489–495.
  59. Ma S, Liu S, Huang L, et al. A meta-analysis of the effect of enhanced hand hygiene on the morbidity of ventilator-associated pneumonia. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2014;26:304–308.
  60. Kollef MH, Shapiro SD, Fraser VJ, et al. Mechanical ventilation with or without 7-day circuit changes: a randomized controlled trial. Ann Intern Med. 1995;123:168–174.
  61. Han J, Liu Y. Effect of ventilator circuit changes on ventilator-associated pneumonia: a systematic review and meta-analysis. Respir Care. 2010;55:467–474.
  62. Dezfulian C, Shojania K, Collard HR, et al. Subglottic secretion drainage for preventing ventilator-associated pneumonia: a meta-analysis. Am J Med. 2005;118:11–18.
  63. Muscedere J, Rewa O, McKechnie K, et al. Subglottic secretion drainage for the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis. Crit Care Med. 2011;39:1985–1991.
  64. Caroff DA, Li L, Muscedere J, et al. Subglottic secretion drainage and objective outcomes: a systematic review and meta-analysis. Crit Care Med. 2016;44:830–840.
  65. Zheng R-Q, Lin H, Shao J, et al. A clinical study of subglottic secretion drainage for prevention of ventilation associated pneumonia. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2008;20:338–340.
  66. Mastrogianni M, Katsoulas T, Galanis P, et al. The impact of care bundles on ventilator-associated pneumonia (VAP) prevention in adult ICUs: a systematic review. Antibiotics (Basel). 2023;12:227.
  67. Sole ML, Penoyer DA, Su X, et al. Assessment of endotracheal cuff pressure by continuous monitoring: a pilot study. Am J Crit Care. 2009;18:133–143.
  68. Nseir S, Lorente L, Ferrer M, et al. Continuous control of tracheal cuff pressure for VAP prevention: a collaborative meta-analysis of individual participant data. Ann Intensive Care. 2015;5:43.
  69. Nseir S, Zerimech F, Fournier C, et al. Continuous control of tracheal cuff pressure and microaspiration of gastric contents in critically ill patients. Am J Respir Crit Care Med. 2011;184:1041–1047.
  70. Letvin A, Kremer P, Silver PC, et al. Frequent versus infrequent monitoring of endotracheal tube cuff pressures. Respir Care. 2018;63:495–501.
  71. Marjanovic N, Boisson M, Asehnoune K, et al. Continuous pneumatic regulation of tracheal cuff pressure to decrease ventilator-associated pneumonia in trauma patients who were mechanically ventilated: the AGATE multicenter randomized controlled study. Chest. 2021;160:499–508.
  72. Monsel A, Lu Q, Le Corre M, et al. Tapered-cuff endotracheal tube does not prevent early postoperative pneumonia compared with spherical-cuff endotracheal tube after major vascular surgery: a randomized controlled trial. Anesthesiology. 2016;124:1041–1052.
  73. Philippart F, Gaudry S, Quinquis L, et al. Randomized intubation with polyurethane or conical cuffs to prevent pneumonia in ventilated patients. Am J Respir Crit Care Med. 2015;191:637–645.
  74. Jaillette E, Brunin G, Girault C, et al. Impact of tracheal cuff shape on microaspiration of gastric contents in intubated critically ill patients: study protocol for a randomized controlled trial. Trials. 2015;16:429.
  75. Dewavrin F, Zerimech F, Boyer A, et al. Accuracy of alpha amylase in diagnosing microaspiration in intubated critically-ill patients. PLoS One. 2014;9:e90851.
  76. Maertens B, Blot K, Blot S. Prevention of ventilator-associated and early postoperative pneumonia through tapered endotracheal tube cuffs: a systematic review and meta-analysis of randomized controlled trials. Crit Care Med. 2018;46:316–323.
  77. Kollef MH, Afessa B, Anzueto A, et al. Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial. JAMA. 2008;300:805–813.
  78. Branch-Elliman W, Wright SB, Howell MD. Determining the ideal strategy for ventilator-associated pneumonia prevention: cost–benefit analysis. Am J Respir Crit Care Med. 2015;192:57–63.
  79. Shorr AF, Zilberberg MD, Kollef M. Cost-effectiveness analysis of a silver-coated endotracheal tube to reduce the incidence of ventilator-associated pneumonia. Infect Control Hosp Epidemiol. 2009;30:759–763.
  80. Pirrone M, Imber DAE, Marrazzo F, et al. Silver-coated endotracheal tubes cleaned with a mechanism for secretion removal. Respir Care. 2019;64:1–9.
  81. Reignier J, Mercier E, Le Gouge A, et al. Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial. JAMA. 2013;309:249–256.
  82. Yasuda H, Kondo N, Yamamoto R, et al. Monitoring of gastric residual volume during enteral nutrition. Cochrane Database Syst Rev. 2021;9:CD013335.
  83. Leone M, Bouadma L, Bouhemad B, et al. Hospital-acquired pneumonia in ICU. Anaesth Crit Care Pain Med. 2018;37:83–98.
  84. de Smet AMGA, Kluytmans JW, Cooper BS, et al. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med. 2009;360:20–31.
  85. Oostdijk EAN, Kesecioglu J, Schultz MJ, et al. Notice of retraction and replacement: Oostdijk et al. Effects of decontamination of the oropharynx and intestinal tract on antibiotic resistance in ICUs: a randomized clinical trial. JAMA. 2017;317:1583–1584.
  86. Roquilly A, Marret E, Abraham E, et al. Pneumonia prevention to decrease mortality in intensive care unit: a systematic review and meta-analysis. Clin Infect Dis. 2015;60:64–75.
  87. Hammond NE, Myburgh J, Seppelt I, et al. Association between selective decontamination of the digestive tract and in-hospital mortality in intensive care unit patients receiving mechanical ventilation: a systematic review and meta-analysis. JAMA. 2022;328:1922–1934.
  88. Myburgh JA, Seppelt IM, Goodman F, et al. Effect of selective decontamination of the digestive tract on hospital mortality in critically ill patients receiving mechanical ventilation: a randomized clinical trial. JAMA. 2022;328:1911–1921.
  89. Daneman N, Sarwar S, Fowler RA, et al. Effect of selective decontamination on antimicrobial resistance in intensive care units: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13:328–341.
  90. Wittekamp BHJ, Oostdijk EAN, de Smet AMGA, et al. Colistin and tobramycin resistance during long-term use of selective decontamination strategies in the intensive care unit: a post hoc analysis. Crit Care. 2015;19:113.
  91. de Smet AMGA, Kluytmans JW, Blok HEM, et al. Selective digestive tract decontamination and selective oropharyngeal decontamination and antibiotic resistance in patients in intensive-care units: an open-label, clustered group-randomised, crossover study. Lancet Infect Dis. 2011;11:372–380.
  92. Houben AJM, Oostdijk EAN, van der Voort PHJ, et al. Selective decontamination of the oropharynx and the digestive tract, and antimicrobial resistance: a 4-year ecological study in 38 intensive care units in the Netherlands. J Antimicrob Chemother. 2014;69:797–804.
  93. van der Bij AK, Frentz D, Bonten MJM; ISIS-AR Study Group. Gram-positive cocci in Dutch ICUs with and without selective decontamination of the oropharyngeal and digestive tract: a retrospective database analysis. J Antimicrob Chemother. 2016;71:816–820.
  94. Oostdijk EAN, de Smet AMGA, Blok HEM, et al. Ecological effects of selective decontamination on resistant gram-negative bacterial colonization. Am J Respir Crit Care Med. 2010;181:452–457.
  95. Frencken JF, Wittekamp BHJ, Plantinga NL, et al. Associations between enteral colonization with Gram-negative bacteria and intensive care unit-acquired infections and colonization of the respiratory tract. Clin Infect Dis. 2018;66:497–503.
  96. Torres A, Niederman MS, Chastre J, et al. Summary of the international clinical guidelines for the management of hospital-acquired and ventilator-acquired pneumonia. ERJ Open Res. 2018;4:00028-2018.
  97. Wittekamp BJH, Oostdijk EAN, Cuthbertson BH, et al. Selective decontamination of the digestive tract (SDD) in critically ill patients: a narrative review. Intensive Care Med. 2020;46:343–349.
  98. Gu W-J, Gong Y-Z, Pan L, et al. Impact of oral care with versus without toothbrushing on the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis of randomized controlled trials. Crit Care. 2012;16:R190.
  99. Silva PUJ, Paranhos LR, Meneses-Santos D, et al. Combination of toothbrushing and chlorhexidine compared with exclusive use of chlorhexidine to reduce the risk of ventilator-associated pneumonia: a systematic review with meta-analysis. Clinics. 2021;76:e2659.
  100. DeRiso AJ, Ladowski JS, Dillon TA, et al. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest. 1996;109:1556–1561.
  101. Labeau SO, Van de Vyver K, Brusselaers N, et al. Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis. Lancet Infect Dis. 2011;11:845–854.
  102. Chan EY, Ruest A, Meade MO, et al. Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis. BMJ. 2007;334:889.
  103. Hua F, Xie H, Worthington HV, et al. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev. 2016;10:CD008367.
  104. Price R, MacLennan G, Glen J; SuDDICU Collaboration. Selective digestive or oropharyngeal decontamination and topical oropharyngeal chlorhexidine for prevention of death in general intensive care: systematic review and network meta-analysis. BMJ. 2014;348:g2197.
  105. Klompas M, Speck K, Howell MD, et al. Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis. JAMA Intern Med. 2014;174:751–761.
  106. Dai W, Yang X, Huang P, et al. Meta-analysis of the efficacy and safety of chlorhexidine for ventilator-associated pneumonia prevention in mechanically ventilated patients. Evid Based Complement Alternat Med. 2022;2022:5311034.
  107. Cruz JC, Martins CK, Piassi JEV, et al. Does chlorhexidine reduce the incidence of ventilator-associated pneumonia in ICU patients? A systematic review and meta-analysis. Med Intensiva. 2022;S2173-5727(22)00329-3.
  108. Righy C, Brasil PEA, Vallés J, et al. Systemic antibiotics for preventing ventilator-associated pneumonia in comatose patients: a systematic review and meta-analysis. Ann Intensive Care. 2017;7:67.
  109. François B, Cariou A, Clere-Jehl R, et al. Prevention of early ventilator-associated pneumonia after cardiac arrest. N Engl J Med. 2019;381:1831–1842.
  110. Bo L, Li J, Tao T, et al. Probiotics for preventing ventilator-associated pneumonia. Cochrane Database Syst Rev. 2014;CD009066.
  111. Morrow LE, Kollef MH, Casale TB. Probiotic prophylaxis of ventilator-associated pneumonia: a blinded, randomized, controlled trial. Am J Respir Crit Care Med. 2010;182:1058–1064.
  112. Johnstone J, Meade M, Lauzier F, et al. Effect of probiotics on incident ventilator-associated pneumonia in critically ill patients: a randomized clinical trial. JAMA. 2021;326:1024–1033
Read More
Author biographies is not available.
Download
PDF
Statistic
Read Counter : 293 Download : 210