VAP prevention

Web site designed and maintained by Chris Cairns © SICS EBM Group 2004

Prevention of VAP

Principal investigator: Dr David Swann

Investigators: Dr Joyce Stuart, Dr Barbara Miles, Mo Al-Haddad, Dr David Swann

Investigating prevention of ventilator associated pneumonia

Current State: Complete, Submitted November 2004, Published December 2004. (HMEs updated Sepember 2005).

Preventing Ventilator-Associated Pneumonia (VAP)

Critical Appraisal Tools have been used to assess RCTs about preventing VAP. Many of the studies were too small to provide an answer to the question, “ Does this intervention prevent VAP? ” However, meta-analysis of high quality RCTs, without adjustment for heterogeneity, allows us to recommend that clinicians should consider using the following interventions:

Sitting intubated patients up at 30-45^oCAT
Using sub-glottic drainage tracheal tubes. Review
Non-invasive ventilation. Review
Using Heat & Moisture Exchange Filters instead of Heated Water Humidification. Review Updated September 2005.

The impact of each of these interventions is assessed in individual reviews by the investigators.

The poor methodological quality of available RCTs on the use of kinetic beds precludes our recommendation.

We have not considered any measures that may prevent any type of nosocomial infection, such as hand-hygiene, immuno-nutrition and selective decontamination of the digestive tract.

These findings are in accord with an evidence-based guideline for the prevention of VAP from the Canadian Critical Care Trials Group, published after our appraisal.

Evidence-Based Clinical Practice Guideline for the Prevention of Ventilator-Associated Pneumonia, Dodek P. et al., Ann Intern Med. 2004;141:305-313.

David Swann, November 2004

Reviewed and Edited by BC & CC