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Prevention
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Fletcher AJ et Al.
About this article: "This is a review article about the design and utility of the LoTrach endotracheal tube. This tube allows to intermittent subglottic suction with a syringe by means of 3 different channels that join to form one tube opening at the proximal end of the tube. The rationale of using intermittent suctioning is because continuous suctioning has been associated with posterior tracheal wall injury."
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Diagnosis
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Luyt CE et Al
About this article: "Luyt and colleagues assessed the diagnostic value of procalcitonin in VAP. They studied mechanically ventilated patients with and without VAP. In this heterogeneous population and in contrast with other study they found that procalcitonin had a poor diagnostic value in the setting of VAP."
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Treatment
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Roberts JA et Al
About this article: "This is a review article on the literature related to administration of antibiotics by extended infusion. After this revision authors concluded that a large scale multicenter, randomized study is needed to determine the beneficial effects of this strategy for antibiotic administration."
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Prevention
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Matsushima A et Al
About this article: "Patients with ARDS have frequently VAP as a complication. The authors performed a before and after study given preemptive antibiotic therapy in patients with ARDS. The incidence of VAP decreased from 22% to 9% in the second period. Antibiotic therapy was administered according to Gram-stain results. They recommend this strategy in patients with ARDS."
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Treatment
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Falagas ME et Al
About this article: "These authors provide information on 7 studies that used inhaled antibiotics to treat nosocomial and community acquired infections due to Gram-negative and Gram-positive microorganisms. Colistin, penicillin and aminoglycosides where the used antibiotics. The authors concluded that due to the scarce information of the published data this precludes strong conclusions, and they encourage to perform more trials in this field."
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Prevention
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Manzano F et Al
About this article: “In this multicenter randomized control clinical trial patients were allocated to receive mechanical ventilation with 5-8 cm H2O of PEEP or no-PEEP. Although hospital mortality was similar when comparing the 2 populations the incidence of ventilator-associated pneumonia was reduced from 25 to 9,5 %. The mechanism and the rational of this measure needs further clarification.”
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Cost
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Kollef KE et Al
About this article: "This is a retrospective study aimed to calculate the cost of ventilator associated pneumonia due to potentially antibiotic resistant Gram-negative bacteria. The study confirms the clear association between inappropriate initial antibiotic therapy and 30 day mortality. Surprisingly, the total hospitalization cost was statistically similar in patients that received inappropriate or appropriate initial antibiotic treatment."
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Prevention
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Kollef MH et Al
About this article: “In this randomized study authors demonstrate that the use of silver coated endotracheal tubes reduces the incidence of ventilator-associated pneumonia and decreases the time of VAP appearance. The relative risk reduction was 35,9 %. However, the small absolute reduction of VAP incidence from 7,5 to 4,8 preclude to take definitive conclusions about the effectivity of this measure.”
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Treatment
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Palmer LB
About this article: "Tracheobronchitis is a controversial infection in mechanically ventilated patients as regards the necessity of systemic antibiotic treatment. In this double-blind randomized placebo-controlled study, the administration of aerosolized antibiotics, decreased VAP, facilitated weaning and very importantly reduced bacterial resistance and the necessity of systemic antibiotics."
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Last Updated ( Friday, 05 September 2008 )
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Prevention
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Westwell S
About this Article: "This manuscript deals with the implementation of bundles for the prevention of VAP. They confirmed that the implementation of these bundles was not completely followed until daily audits were performed."
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Epidemiology: Risk and prognosis factors
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Pellegrino CM et Al
About this article: "The crude incidence of VAP in patients undergoing orthotopic liver transplantation was 27%. However, this incidence was not increased compared to surgical non-transplanted patients. The crude mortality was increased in patients with VAP."
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Last Updated ( Friday, 06 March 2009 )
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Treatment
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Fujita T et Al
About this article: "This is another compelling evidence of the importance of adequate initial antibiotic therapy in VAP. In this specific case the multivariate analysis confirmed its importance in a series of patients with postoperative pneumonia (OR=16.75)."
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Etiology
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Visscher S et Al
About this article: "This group from the Netherlands developed a Bayesian model for the prediction of microbial etiology in ventilator-associated pneumonia. Using this model 85% and 63% of all pathogen groups were correctly predicted for monobacterial and polymicrobial VAP. More importantly, using this model 92% would have been treated adequately"
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Treatment
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Karageorgopoulos DE et Al
About this article: "Tigecycline is an antibiotic of the family of tetracyclines aimed to treat Gram positive infections and multidrug-resistant pathogens excluding Pseudomonas aeruginosa. This a review of cases of MDR Acinetobacter that were treated with this new antibiotic. Tigecycline was effective in 32 of 42 cases. Resistance was developed in three cases during treatment. Despite this information there is not enough data to support its use in ventilator-associated pneumonia or bacteremia."
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Diagnosis
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Masterton RG et Al
About this article: "This is new set of recommendations for hospital-acquired pneumonia elaborated by experts from the British Society for Antimicrobial Therapy. Specifically they provide evidence-based recommendations for diagnosis, prevention and treatment."
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Prevention
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Lyerla F
About this article: "Semirecumbent position is a recommended prophylactic measure for ventilator-associated pneumonia recommended by the Center for Disease Control. However the adherence to this rule is not adequate. The authors of this manuscript describe a system of implementation of this measure based on a form reminder that helped nurses to adhere to this recommendation."
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