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Respiratory - VAP

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Early-Onset Ventilator-Associated Pneumonia in Patients with Severe Traumatic Brain Injury: Incidence, Risk Factors, and Consequences in Cerebral Oxygenation and Outcome.
Esnault P, Nguyen C, Bordes J, D'Aranda E, Montcriol A, Contargyris C, Cotte J, Goutorbe P, Joubert C, Dagain A, Boret H, Meaudre E.
Neurocrit Care. 2017 Oct;27(2):187-198

Rationale for inclusion: These authors described risk factors, incidence, and characteristics of early onset VAP in patients with severe TBI, identifying four main risk factors: therapeutic hypothermia use, thoracic AIS>3, positive admission ET aspiration, and aspiration events.  Early onset VAP was an independent risk factor for poor neurologic outcome at 1 year. 

CAVEAT: Single center study

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Executive Summary: 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.
Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, Napolitano LM, O'Grady NP, Bartlett JG, Carratalà J, El Solh AA, Ewig S, Fey PD, File TM Jr, Restrepo MI, Roberts JA, Waterer GW, Cruse P, Knight SL, Brozek JL.
Clin Infect Dis. 2016 Sep 1;63(5):575-82.

Rationale for inclusion: IDSA guidelines for management of pneumonia. 

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Short- vs long-duration antibiotic regimens for ventilator-associated pneumonia: a systematic review and meta-analysis.
Dimopoulos G, Poulakou G, Pneumatikos IA, Armaganidis A, Kollef MH, Matthaiou DK.
Chest. 2013 Dec;144(6):1759-67.

Rationale for inclusion: Meta analysis for the duration of antibiotics in VAP (more antibiotics free days, less relapse, no difference in mortality).

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Economic impact of ventilator-associated pneumonia in a large matched cohort.
Kollef MH, Hamilton CW, Ernst FR.
Infect Control Hosp Epidemiol. 2012 Mar;33(3):250-6.

Rationale for inclusion: Well done description of the cost of VAP to the hospital admission.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Reducing ventilator-associated pneumonia in intensive care: impact of implementing a care bundle.
Morris AC, Hay AW, Swann DG, Everingham K, McCulloch C, McNulty J, Brooks O, Laurenson IF, Cook B, Walsh TS.
Crit Care Med. 2011 Oct;39(10):2218-24.

Rationale for inclusion: VAP Bundle in the ICU.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial.
Kollef MH, Afessa B, Anzueto A, Veremakis C, Kerr KM, Margolis BD, Craven DE, Roberts PR, Arroliga AC, Hubmayr RD, Restrepo MI, Auger WR, Schinner R; NASCENT Investigation Group.
JAMA. 2008 Aug 20;300(7):805-13.

Rationale for inclusion: Silver coated ET tubes reduce risk of pneumonia.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Randomized trial of combination versus monotherapy for the empiric treatment of suspected ventilator-associated pneumonia.
Heyland DK, Dodek P, Muscedere J, Day A, Cook D; Canadian Critical Care Trials Group.
Crit Care Med. 2008 Mar;36(3):737-44.

Rationale for inclusion: Adequacy of monotherapy in VAP with low risk of difficult to treat gram negative infection. 

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Impact of inappropriate antibiotic therapy on mortality in patients with ventilator-associated pneumonia and blood stream infection: a meta-analysis.
Kuti EL, Patel AA, Coleman CI.
J Crit Care. 2008 Mar;23(1):91-100.

Rationale for inclusion: Meta-analysis of the impact of inappropriate initial antibiotics on mortality.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Oral decontamination with chlorhexidine reduces the incidence of ventilator-associated pneumonia.
Koeman M, van der Ven AJ, Hak E, Joore HC, Kaasjager K, de Smet AG, Ramsay G, Dormans TP, Aarts LP, de Bel EE, Hustinx WN, van der Tweel I, Hoepelman AM, Bonten MJ.
Am J Respir Crit Care Med. 2006 Jun 15;173(12):1348-55.

Rationale for inclusion: Chlorhexidine oral decontamination to reduce VAP.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Candida colonization of the respiratory tract and subsequent pseudomonas ventilator-associated pneumonia.
Azoulay E, Timsit JF, Tafflet M, de Lassence A, Darmon M, Zahar JR, Adrie C, Garrouste-Orgeas M, Cohen Y, Mourvillier B, Schlemmer B; Outcomerea Study Group.
Chest. 2006 Jan;129(1):110-7.

Rationale for inclusion: Colonization of airway with candida in mechanical ventilation more than 2 days and associated morbidities. 

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia.
Resar R, Pronovost P, Haraden C, Simmonds T, Rainey T, Nolan T.
Jt Comm J Qual Patient Saf. 2005 May;31(5):243-8.

Rationale for inclusion: The Joint Commission bundle for VAP prevention.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Invasive approaches to the diagnosis of ventilator-associated pneumonia: a meta-analysis.
Shorr AF, Sherner JH, Jackson WL, Kollef MH.
Crit Care Med. 2005 Jan;33(1):46-53.

Rationale for inclusion: Meta-analysis of the invasive methods to diagnose VAP - no effect on mortality, but change in antibiotics choice. 

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Value of the clinical pulmonary infection score for the identification and management of ventilator-associated pneumonia.
Luyt CE, Chastre J, Fagon JY.
Intensive Care Med. 2004 May;30(5):844-52.

Rationale for inclusion: CPIS should be followed by bronchoscopy for the diagnosis of VAP.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Clinical pulmonary infection score for ventilator-associated pneumonia: accuracy and inter-observer variability.
Schurink CA, Van Nieuwenhoven CA, Jacobs JA, Rozenberg-Arska M, Joore HC, Buskens E, Hoepelman AI, Bonten MJ.
Intensive Care Med. 2004 Feb;30(2):217-24.

Rationale for inclusion: CPIS has low sens and spec and high inter-rater variability for dx of VAP.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial.
Chastre J, Wolff M, Fagon JY, Chevret S, Thomas F, Wermert D, Clementi E, Gonzalez J, Jusserand D, Asfar P, Perrin D, Fieux F, Aubas S; PneumA Trial Group.
JAMA. 2003 Nov 19;290(19):2588-98.

Rationale for inclusion: 1 week vs 2 weeks of Abx for VAP.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Resolution of ventilator-associated pneumonia: prospective evaluation of the clinical pulmonary infection score as an early clinical predictor of outcome.
Luna CM, Blanzaco D, Niederman MS, Matarucco W, Baredes NC, Desmery P, Palizas F, Menga G, Rios F, Apezteguia C.
Crit Care Med. 2003 Mar;31(3):676-82.

Rationale for inclusion: CPIS to follow resolution of pneumonia.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Rotation and restricted use of antibiotics in a medical intensive care unit. Impact on the incidence of ventilator-associated pneumonia caused by antibiotic-resistant gram-negative bacteria.
Gruson D, Hilbert G, Vargas F, Valentino R, Bebear C, Allery A, Bebear C, Gbikpi-Benissan G, Cardinaud JP.
Am J Respir Crit Care Med. 2000 Sep;162(3 Pt 1):837-43.

Rationale for inclusion: This paper introduces the concept of rotating empiric Abx for the Rx of VAP.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Impact of BAL data on the therapy and outcome of ventilator-associated pneumonia.
Luna CM, Vujacich P, Niederman MS, Vay C, Gherardi C, Matera J, Jolly EC.
Chest. 1997 Mar;111(3):676-85.

Rationale for inclusion: Guiding study for use of BAL in diagnosis of VAP.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia.
Vallés J, Artigas A, Rello J, Bonsoms N, Fontanals D, Blanch L, Fernández R, Baigorri F, Mestre J.
Ann Intern Med. 1995 Feb 1;122(3):179-86.

Rationale for inclusion: Study introducing the concept of subglottic suction port on ET tubes.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

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