Prevention of hospital-acquired pneumonia: measuring effect in ounces, pounds, and tons

Article Abstract:

Strategies for preventing nosocomial pneumonia should be widely implemented if they are proven to be beneficial and cost-effective in reliable, unbiased studies. Nosocomial, or hospital-acquired, pneumonia is a significant problem in the US. It is often associated with mechanical ventilation, as the endotracheal tube can become contaminated by bacteria in the nose, mouth and throat. Guidelines for prevention of nosocomial pneumonia include inserting tubes through the mouth instead of nose, changing ventilator circuits less frequently and using sucralfate to prevent stress bleeding in the stomach. A recent study suggests that continuous suction of throat secretions in mechanically ventilated patients may also reduce the incidence of nosocomial pneumonia. Preventive antibiotics are not recommended, as they have not been shown to lower the rate of pneumonia, and can instead contribute to drug resistance. Isolation of patients with respiratory tract infections may also be a useful strategy, as well as better compliance with hand-washing by hospital workers.

Editorial

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Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia

Article Abstract:

Continuous aspiration of throat secretions may reduce the incidence of ventilator-associated pneumonia. Pneumonia is common among mechanically ventilated patients, occurring when bacteria enter the lungs through the cuff of endotracheal tubes. Of 153 patients receiving mechanical ventilation with the same kind of tube, 76 also received continuous aspiration (suction) of secretions from below the voice box and 77 did not (control group). Fourteen (18.4%) of the patients receiving aspiration developed pneumonia, versus 25 (32.5%) of the control patients. Pneumonia developed later on average in the aspiration group than in the control group (12 days vs six days). Analysis of the aspirated secretions revealed microorganisms that often cause ventilator-associated pneumonia, suggesting that suctioning these secretions can help prevent the bacteria from entering the endotracheal tube, thus reducing the risk of pneumonia.

Usage, Aspiration and aspirators, Aspiration (Physiology)

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Ventilator-associated pneumonia

Article Abstract:

There may be several ways to prevent ventilator-associated pneumonia in patients on a ventilator, according to researchers who analyzed the medical literature on this topic. Effective methods include raising the patients head to a 45-degree angle, using sucralfate instead of H(sub 2)-blockers to prevent stress ulcers, and suctioning the throats of patients who are on a ventilator for more than three days. On the other hand, changing ventilator circuitry or filters frequently did not lower the risk of pneumonia.

Care and treatment, Critically ill

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