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Research ArticleConference Proceedings

Ventilator-Associated Pneumonia: Issues Related to the Artificial Airway

Emili Diaz, Alejandro H Rodríguez and Jordi Rello
Respiratory Care July 2005, 50 (7) 900-909;
Emili Diaz
Critical Care Department, University Rovira and Virgili. Institut Pere Virgili, Joan XXIII University Hospital, Tarragona, Spain.
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Alejandro H Rodríguez
Critical Care Department, University Rovira and Virgili. Institut Pere Virgili, Joan XXIII University Hospital, Tarragona, Spain.
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Jordi Rello
Critical Care Department, University Rovira and Virgili. Institut Pere Virgili, Joan XXIII University Hospital, Tarragona, Spain.
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Abstract

Pooling of contaminated secretions above the cuff of the endotracheal tube predisposes patients to ventilator-associated pneumonia (VAP). Subglottic secretion drainage requires a special endotracheal tube that has a separate lumen that opens in the subglottic region above the tracheal tube. A recent meta-analysis of the 5 randomized clinical trials that evaluated the efficacy of removing these secretions found that this technique significantly reduces the incidence of VAP. One cost-effectiveness analysis showed savings of $4,900 per episode of VAP prevented. Greatest benefit is derived by patients requiring fewer than 10 days of mechanical ventilation and not exposed to antibiotic therapy. Maintaining the intracuff pressure between 25 and 30 cm H2O is mandatory to guarantee effective drainage and safety. While silver-coated endotracheal tubes reduce pseudomonas pneumonia in intubated dogs and delay airway colonization in intubated patients, evaluation of studies with a variety of case mixes is warranted to identify subsets likely to benefit from the technique before it is implemented on a large scale. A patient who has a colonized airway and who undergoes percutaneous tracheotomy has an increased risk of VAP, particularly due to Pseudomonas aeruginosa, in the week following the procedure. As many studies suggest that incidence of VAP is highly dependent on the strategies of airway management, health care workers should be alerted to issues related to the artificial airway.

  • ventilator-associated pneumonia
  • VAP
  • artificial airway
  • subglottic secretion drainage
  • silver-coated endotracheal tube
  • tracheotomy

Footnotes

  • Correspondence: Jordi Rello MD PhD, Critical Care Department, Joan XXIII University Hospital, Carrer Dr Mallafre Guasch 4, 43007 Tarragona, Spain. E-mail: jrc{at}hjxxiii.scs.es.
  • Jordi Rello MD PhD presented a version of this article at the 35th Respiratory Care Journal Conference, Ventilator-Associated Pneumonia, held February 25–27, 2005, in Cancún, Mexico.

  • Copyright © 2005 by Daedalus Enterprises Inc.
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Respiratory Care: 50 (7)
Respiratory Care
Vol. 50, Issue 7
1 Jul 2005
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Ventilator-Associated Pneumonia: Issues Related to the Artificial Airway
Emili Diaz, Alejandro H Rodríguez, Jordi Rello
Respiratory Care Jul 2005, 50 (7) 900-909;

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Ventilator-Associated Pneumonia: Issues Related to the Artificial Airway
Emili Diaz, Alejandro H Rodríguez, Jordi Rello
Respiratory Care Jul 2005, 50 (7) 900-909;
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Keywords

  • ventilator-associated pneumonia
  • VAP
  • artificial airway
  • subglottic secretion drainage
  • silver-coated endotracheal tube
  • tracheotomy

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