Clinical review: Airway hygiene in the intensive care unit

Critical Care

Volumn 12, Issue 2, 2008, Pages

  Jelic, Sanja ^a   Cunningham, Jennifer A ^a   Factor, Phillip ^a  

^a New York Presbyterian Columbia University Medical Center   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ACETYLCYSTEINE; AMINOGLYCOSIDE ANTIBIOTIC AGENT; AMPHOTERICIN B; BETA 2 ADRENERGIC RECEPTOR STIMULATING AGENT; BETA LACTAM ANTIBIOTIC; BRONCHODILATING AGENT; CHLORHEXIDINE GLUCONATE; DORNASE ALFA; GENTAMICIN; ISEGANAN; MUCOLYTIC AGENT; POLYMYXIN; SALBUTAMOL; TOBRAMYCIN; VANCOMYCIN; ANTIINFECTIVE AGENT; EXPECTORANT AGENT;

ANTIINFLAMMATORY ACTIVITY; ARTIFICIAL VENTILATION; ATELECTASIS; BREATHING EXERCISE; BRONCHIECTASIS; BRONCHOSCOPY; BRONCHOSPASM; CHRONIC OBSTRUCTIVE LUNG DISEASE; CLINICAL TRIAL; COST EFFECTIVENESS ANALYSIS; CRITICALLY ILL PATIENT; CYSTIC FIBROSIS; DRUG ANTAGONISM; DRUG EFFICACY; HEALTH CARE COST; HOSPITAL HYGIENE; HOSPITAL INFECTION; HUMAN; INCIDENCE; INFECTION RISK; INFECTIOUS PNEUMONIA; INTENSIVE CARE; INTENSIVE CARE UNIT; LENGTH OF STAY; MORTALITY; MOUTH HYGIENE; POSITIVE END EXPIRATORY PRESSURE; PRIORITY JOURNAL; RESPIRATORY TRACT INFECTION; REVIEW; RISK FACTOR; TRACHEOBRONCHIAL TOILET; VENTILATOR ASSOCIATED PNEUMONIA; CROSS INFECTION; HYGIENE; METHODOLOGY; RESPIRATORY TRACT MUCOSA; SECRETION; STANDARD; STATISTICS; SUCTION; WASTE MANAGEMENT;

ANTI-INFECTIVE AGENTS; BRONCHOSCOPY; CROSS INFECTION; DECONTAMINATION; EXPECTORANTS; HOSPITAL MORTALITY; HUMANS; HYGIENE; INTENSIVE CARE UNITS; LENGTH OF STAY; RESPIRATORY MUCOSA; RESPIRATORY TRACT INFECTIONS; RISK FACTORS; SUCTION;

EID: 43849095023     PISSN: 13648535     EISSN: 1466609X     Source Type: Journal    
DOI: 10.1186/cc6830     Document Type: Review

References (143)

1. Kollef MH The prevention of ventilator-associated pneumonia New Engl J Med 1999, 340:627-634 10.1056/NEJM199902253400807 10029648
2. Levine SA Niederman MS The impact of tracheal intubation on host defenses and risks for nosocomial pneumonia Clin Chest Med 1991, 12:523-543 1934953
3. Weinmeister KD Dal Nogare AR Buccal cell carbohydrates are altered during critical illness Am J Respir Crit Care Med 1994, 150:131-134 8025738
4. Woods DE Straus DC Johanson WG Jr Bass JA Role of fibronectin in the prevention of adherence of Pseudomonas aeruginosa to buccal cells J Infect Dis 1981, 143:784-790 6788858
5. Woods DE Straus DC Johanson WG Brass JA Role of salivary protease activity in adherence of gram-negative bacilli to mammalian buccal epithelial cells in vivo J Clin Invest 1981, 68:1435-1440 370945 6798070 10.1172/JCI110395
6. American Thoracic Society Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies. A consensus statement, November 1995 Am J Respir Crit Care Med 1996, 153:1711-1725 8630626
7. Garrouste-Orgeas M Chevret S Arlet G Marie O Rouveau M Popoff N Schlemmer B Oropharyngeal or gastric colonization and nosocomial pneumonia in adult intensive care unit patients Am J Respir Crit Care Med 1997, 156:1647-1655 9372689
8. Bonten MJ Gaillard CA vanTiel FH Smeets HG vanderGeest S Stobberingh EE The stomach is not a source for colonization of the upper respiratory tract and pneumonia in ICU patients Chest 1994, 105:878-884 10.1378/ chest.105.3.878 8131556
9. Cardenosa Cendrero JA Sole-Violan J Bordes Benitez A Noguera Catalan J Arroyo Fernandez J Saavedra Santana P Rodriguez de Castro F Role of different routes of tracheal colonization in the development of pneumonia in patients receiving mechanical ventilation Chest 1999, 116:462-470 10.1378/chest.116.2.462 10453877
10. Bonten MJ Bergmans DC Ambergen AW deLeeuw PW van-derGeest S Stobberingh EE Gaillard CA Risk factors for pneumonia, and colonization of respiratory tract and stomach in mechanically ventilated ICU patients Am J Respir Crit Care Med 1996, 154:1339-1346 8912745
11. DeRiso AJ Ladowski JS Dillon TA Justice JW Peterson AC Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery Chest 1996, 109:1556-1561 10.1378/ chest.109.6.1556 8769511
12. Genuit T Bochicchio G Napolitano LM McCarter RJ Roghman MC Prophylactic chlorhexidine oral rinse decreases ventilator-associated pneumonia in surgical ICU patients Surg Infect (larch mt) 2001, 2(1):5-18 10.1089/ 109629601750185316 12594876
13. Houston S Hougland P Anderson JJ LaRocco M Kennedy V Gentry LO Effectiveness of 0.12% chlorhexidine gluconate oral rinse in reducing prevalence of nosocomial pneumonia in patients undergoing heart surgery Am J Crit Care 2002, 11:567-570 12425407
14. Segers P Speekenbrink RG Ubbink DT van Ogtrop ML de Mol BA Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate: A randomized controlled trial JAMA 2006, 296:2460-2466 10.1001/jama.296.20.2460 17119142
15. Bergmans DC Bonten MJ Gaillard CA Paling JC vanderGeest S vanTiel FH Beysens AJ deLeeuw PW Stobberingh EE Prevention of ventilator-associated pneumonia by oral decontamination. A prospective, randomized, double-blind, placebo-controlled study Am J Respir Crit Care Med 2001, 164:382-388 11500337
16. Pugin J Auckenthaler R Lew DP Suter PM Oropharyngeal decontamination decreases incidence of ventilator-associated pneumonia. A randomized, placebo-controlled, double-blind clinical trial JAMA 1991, 265:2704-2710 10.1001/jama.265.20.2704 2023353
17. Gastinne H Wolff M Delatour F Faurisson F Chevret S A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibiotics New Engl J Med 1992, 326:594-599 1734249
18. Selective Decontamination of the Digestive Tract Trialists' Collaborative Group Meta-analysis of randomised controlled trials of selective decontamination of the digestive tract BMJ 1993, 307:525-532 1678619 8400971
19. D'Amico R Pifferi S Leonetti C Torri V Tinazzi A Liberati A Effectiveness of antibiotic prophylaxis in critically ill adult patients: Systematic review of randomised controlled trials BMJ 1998, 316:1275-1285 28528 9554897
20. Heyland DK Cook DJ Jaeschke R Griffith L Lee HN Guyatt GH Selective decontamination of the digestive tract. An overview Chest 1994, 105:1221-1229 10.1378/chest.105.4.1221 8018162
21. Hurley JC Prophylaxis with enteral antibiotics in ventilated patients: selective decontamination or selective cross-infection? Antimicrob Agents Chemother 1995, 39:941-947 162658 7786000
22. Kollef MH The role of selective digestive tract decontamination on mortality and respiratory tract infections. A meta-analysis Chest 1994, 105:1101-1108 10.1378/chest.105.4.1101 8162733
23. Liberati A D'Amico R Pifferi S Torri V Brazzi L Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care Cochrane Database Syst Rev 2004, 1:CD000022 14973945
24. Nathens AB Marshall JC Selective decontamination of the digestive tract in surgical patients: A systematic review of the evidence Arch Surg 1999, 134:170-176 10.1001/archsurg.134.2.170 10025458
25. Safdar N Said A Lucey MR The role of selective digestive decontamination for reducing infection in patients undergoing liver transplantation: A systematic review and meta-analysis Liver Transpl 2004, 10:817-827 10.1002/lt.20108 15237363
26. Sun X Wagner DP Knaus WA Does selective decontamination of the digestive tract reduce mortality for severely ill patients? Crit Care Med 1996, 24:753-755 10.1097/00003246-199605000-00005 8706449
27. van Saene HK Stoutenbeek CP Hart CA Selective decontamination of the digestive tract (SDD) in intensive care patients: A critical evaluation of the clinical, bacteriological and epidemiological benefits J Hosp Infect 1991, 18:261-277 10.1016/0195-6701(91)90184-A 1682365
28. Vandenbroucke-Grauls CM Vandenbroucke JP Effect of selective decontamination of the digestive tract on respiratory tract infections and mortality in the intensive care unit Lancet 1991, 338:859-862 10.1016/0140-6736(91)91510-2 1681223
29. vanNieuwenhoven CA Buskens E Bergmans DC vanTiel FH Ramsay G Bonten MJ Oral decontamination is cost-saving in the prevention of ventilator-associated pneumonia in intensive care units Crit Care Med 2004, 32:126-130 10.1097/01.CCM.0000104111.61317.4B 14707570
30. Krueger WA Lenhart FP Neeser G Ruckdeschel G Schreck-hase H Eissner HJ Forst H Eckart J Peter K Unertl KE Influence of combined intravenous and topical antibiotic prophylaxis on the incidence of infections, organ dysfunctions, and mortality in critically ill surgical patients: A prospective, stratified, randomized, double-blind, placebo-controlled clinical trial Am J Respir Crit Care Med 2002, 166:1029-1037 10.1164/ rccm.2105141 12379544
31. Cerda E Abella A de la Cal MA Lorente JA Garcia-Hierro P van Saene HK Alia I Aranguren A Enteral vancomycin controls methicillin-resistant Staphylococcus aureus endemicity in an intensive care burn unit: A 9-year prospective study Ann Surg 2007, 245:397-407 1877020 17435547 10.1097/01.sla.0000250418.14359.31
32. de la Cal MA Cerda E van Saene HK Garcia-Hierro P Negro E Parra ML Arias S Ballesteros D Effectiveness and safety of enteral vancomycin to control endemicity of methicillin-resistant Staphylococcus aureus in a medical/surgical intensive care unit J Hosp Infect 2004, 56:175-183 10.1016/j.jhin.2003.09.021 15003664
33. Kollef MH Selective digestive decontamination should not be routinely employed Chest 2003, 123:464S-468S 10.1378/chest.123.5_suppl.464S 12740230
34. Tablan OC Anderson LJ Arden NH Breiman RF Butler JC McNeil MM Guideline for prevention of nosocomial pneumonia. The Hospital Infection Control Practices Advisory Committee, Centers for Disease Control and Prevention Infect Control Hosp Epidemiol 1994, 15:587-627 7989733
35. Kollef M Pittet D Sánchez García M Chastre J Fagon JY Bonten M Hyzy R Fleming TR Fuchs H Bellm L Mercat A Mañez R Martínez A Eggimann P Daguerre M Luyt CE Prevention of Pneumonia Study (POPS-1) Trial Group A randomized double-blind trial of iseganan in prevention of ventilator-associated pneumonia Am J Respir Crit Care Med 2006, 173:91-97 10.1164/rccm.200504-656OC 16192451
36. Higgins CS Murtough SM Williamson E Hiom SJ Payne DJ Russell AD Walsh TR Resistance to antibiotics and biocides among non-fermenting Gram-negative bacteria Clin Microbiol Infect 2001, 7:308-315 10.1046/ j.1198-743x.2001.00253.x 11442564
37. Russell AD Biocide use and antibiotic resistance: The relevance of laboratory findings to clinical and environmental situations Lancet Infect Dis 2003, 3:794-803 10.1016/S1473-3099(03)00833-8 14652205
38. Keller C Brimacombe J Bronchial mucus transport velocity in paralyzed anesthetized patients: A comparison of the laryngeal mask airway and cuffed tracheal tube Anesth Analg 1998, 86:1280-1282 10.1097/ 00000539-199806000-00028 9620520
39. Konrad F Schiener R Marx T Georgieff M Ultrastructure and mucociliary transport of bronchial respiratory epithelium in intubated patients Intensive Care Med 1995, 21:482-489 10.1007/BF01706201 7560491
40. Sackner MA Hirsch JA Epstein S Rywlin AM Effect of oxygen in graded concentrations upon tracheal mucous velocity. A study in anesthetized dogs Chest 1976, 69:164-167 10.1378/chest.69.2.164 1248269
41. Hornick DB Allen BL Horn MA Clegg S Adherence to respiratory epithelia by recombinant Escherichia coli expressing Klebsiella pneumoniae type 3 fimbrial gene products Infect Immun 1992, 60:1577-1588 257033 1312518
42. Brodsky L Reidy M Stanievich JF The effects of suctioning techniques on the distal tracheal mucosa in intubated low birth weight infants Int J Pediatr Otorhinolaryngol 1987, 14:1-14 10.1016/0165-5876(87)90044-9 3429146
43. Adlkofer RM Powaser MM The effect of endotracheal suctioning on arterial blood gases in patients after cardiac surgery Heart Lung 1978, 7:1011-1014 251166
44. Brown SE Stansbury DW Merrill EJ Linden GS Light RW Prevention of suctioning-related arterial oxygen desaturation. Comparison of off-ventilator and on-ventilator suctioning Chest 1983, 83:621-627 10.1378/chest.83.4.621 6831950
45. Van de Leur JP Zwaveling JH Loef BG Van der Schans CP Endotracheal suctioning versus minimally invasive airway suctioning in intubated patients: A prospective randomised controlled trial Intensive Care Med 2003, 29:426-432 12577156
46. Maggiore SM Lellouche F Pigeot J Taille S Deye N Durrmeyer X Richard JC Mancebo J Lemaire F Brochard L Prevention of endotracheal suctioning-induced alveolar derecruitment in acute lung injury Am J Respir Crit Care Med 2003, 167:1215-1224 10.1164/rccm.200203-195OC 12615633
47. Shim C Fine N Fernandez R Williams MH Jr Cardiac arrhythmias resulting from tracheal suctioning Ann Intern Med 1969, 71:1149-1153 4188323
48. Piepmeier JM Lehmann KB Lane JG Cardiovascular instability following acute cervical spinal cord trauma Cent Nerv Syst Trauma 1985, 2:153-160 3835007
49. Choi JS Jones AY Effects of manual hyperinflation and suctioning in respiratory mechanics in mechanically ventilated patients with ventilator-associated pneumonia Aust J Physiother 2005, 51:25-30 15748122
50. Mancinelli-Van Atta J Beck SL Preventing hypoxemia and hemodynamic compromise related to endotracheal suctioning Am J Crit Care 1992, 1:62-79 1307909
51. Stiller K Physiotherapy in intensive care: Towards an evidence-based practice Chest 2000, 118:1801-1813 10.1378/chest.118.6.1801 11115476
52. Ackerman MH The effect of saline lavage prior to suctioning Am J Crit Care 1993, 2:326-330 8358479
53. Ackerman MH Mick DJ Instillation of normal saline before suctioning in patients with pulmonary infections: A prospective randomized controlled trial Am J Crit Care 1998, 7:261-266 9656040
54. Hagler DA Traver GA Endotracheal saline and suction catheters: Sources of lower airway contamination Am J Crit Care 1994, 3:444-447 7834003
55. Akgul S Akyolcu N Effects of normal saline on endotracheal suctioning J Clin Nurs 2002, 11:826-830 10.1046/j.1365-2702.2002.00655.x 12427189
56. Kinloch D Instillation of normal saline during endotracheal suctioning: effects on mixed venous oxygen saturation Am J Crit Care 1999, 8:231-240 10392222
57. Cordero L Sananes M Ayers LW A comparison of two airway suctioning frequencies in mechanically ventilated, very-low-birthweight infants Respir Care 2001, 46:783-788 11463368
58. Wood CJ Can nurses safely assess the need for endotracheal suction in short-term ventilated patients, instead of using routine techniques? Intensive Crit Care Nurs 1998, 14:170-178 10.1016/S0964-3397(98)80486-2 9849243
59. Deppe SA Kelly JW Thoi LL Chudy JH Longfield RN Ducey JP Truwit CL Antopol MR Incidence of colonization, nosocomial pneumonia, and mortality in critically ill patients using a Trach Care closed-suction system versus an open-suction system: Prospective, randomized study Crit Care Med 1990, 18:1389-1393 10.1097/00003246-199012000-00016 2245613
60. Rabitsch W Kostler WJ Fiebiger W Dielacher C Losert H Sherif C Staudinger T Seper E Koller W Daxbock F Schuster E Knobl P Burgmann H Frass M Closed suctioning system reduces cross-contamination between bronchial system and gastric juices Anesth Analg 2004, 99:886-892 15333426
61. Combes P Fauvage B Oleyer C Nosocomial pneumonia in mechanically ventilated patients, a prospective randomised evaluation of the Stericath closed suctioning system Intensive Care Med 2000, 26:878-882 10.1007/s001340051276 10990101
62. Jongerden IP Rovers MM Grypdonck MH Bonten MJ Open and closed endotracheal suction systems in mechanically ventilated intensive care patients: A meta-analysis Crit Care Med 2007, 35:260-270 10.1097/ 01.CCM.0000251126.45980.E8 17133187
63. Lorente L Lecuona M Martin MM Garcia C Mora ML Sierra A Ventilator-associated pneumonia using a closed versus an open tracheal suction system Crit Care Med 2005, 33:115-119 10.1097/ 01.CCM.0000150267.40396.90 15644657
64. Zeitoun SS de Barros AL Diccini S A prospective, randomized study of ventilator-associated pneumonia in patients using a closed vs. open suction system J Clin Nurs 2003, 12:484-489 10.1046/ j.1365-2702.2003.00749.x 12790861
65. Johnson KL Kearney PA Johnson SB Niblett JB MacMillan NL McClain RE Closed versus open endotracheal suctioning: Costs and physiologic consequences Crit Care Med 1994, 22:658-666 10.1097/ 00003246-199404000-00023 8143475
66. Lorente L Lecuona M Jimenez A Mora ML Sierra A Tracheal suction by closed system without daily change versus open system Intensive Care Med 2006, 32:538-544 10.1007/s00134-005-0057-6 16511633
67. Adams DH Hughes M Elliott TS Microbial colonization of closed-system suction catheters used in liver transplant patients Intensive Crit Care Nurs 1997, 13:72-76 10.1016/S0964-3397(97)80135-8 9180492
68. Zielmann S Grote R Sydow M Radke J Burchardi H Endotracheal suctioning using a 24-hour continuous system. Can costs and waste products be reduced? Anaesthesist 1992, 41:494-498 1524162
69. Kollef MH Prentice D Shapiro SD Fraser VJ Silver P Trovillion E Weilitz P von Harz B St John R Mechanical ventilation with or without daily changes of in-line suction catheters Am J Respir Crit Care Med 1997, 156:466-472 9279225
70. Dezfulian C Shojania K Collard HR Kim HM Matthay MA Saint S Subglottic secretion drainage for preventing ventilator-associated pneumonia: A meta-analysis Am J Med 2005, 118:11-18 10.1016/j.amjmed.2004.07.051 15639202
71. Girou E Buu-Hoi A Stephan F Novara A Gutmann L Safar M Fagon JY Airway colonisation in long-term mechanically ventilated patients. Effect of semi-recumbent position and continuous subglottic suctioning Intensive Care Med 2004, 30:225-233 10.1007/s00134-003-2077-4 14647884
72. Kollef MH Skubas NJ Sundt TM A randomized clinical trial of continuous aspiration of subglottic secretions in cardiac surgery patients Chest 1999, 116:1339-1346 10.1378/chest.116.5.1339 10559097
73. Mahul P Auboyer C Jospe R Ros A Guerin C el Khouri Z Galliez M Dumont A Gaudin O Prevention of nosocomial pneumonia in intubated patients: respective role of mechanical subglottic secretions drainage and stress ulcer prophylaxis Intensive Care Med 1992, 18:20-25 10.1007/BF01706421 1578042
74. Smulders K vanderHoeven H Weers-Pothoff I Vandenbroucke-Grauls C A randomized clinical trial of intermittent subglottic secretion drainage in patients receiving mechanical ventilation Chest 2002, 121:858-862 10.1378/chest.121.3.858 11888973
75. Valles J Artigas A Rello J Bonsoms N Fontanals D Blanch L Fernandez R Baigorri F Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia Ann Intern Med 1995, 122:179-186 7810935
76. Berra L Panigada M De Marchi L Greco G Z-Xi Y Baccarelli A Pohlmann J Costello KF Appleton J Mahar R Lewandowski R Ravitz L Kolobow T New approaches for the prevention of airway infection in ventilated patients. Lessons learned from laboratory animal studies at the National Institutes of Health Minerva Anestesiol 2003, 69:342-347 12768164
77. Shorr AF O'Malley PG Continuous subglottic suctioning for the prevention of ventilator-associated pneumonia. Potential economic implications Chest 2001, 119:228-235 10.1378/chest.119.1.228 11157609
78. Rau JL Mucus-controlling agents Respiratory Care Pharmacology St Louis: Mosby Rau JL 1994 195-222
79. Ackerman MH The use of bolus normal saline instillations in artifical airways: Is it useful or necessary? Heart Lung 1985, 14:505-506 3861597
80. Bostick J Wendelgass ST Normal saline instillation as part of the suctioning procedure: Effects on PaO2 and amount of secretions Heart Lung 1987, 16:532-537 3308779
81. Smith CM Anderson SD A comparison between the airway response to isocapnic hyperventilation and hypertonic saline in subjects with asthma Eur Respir J 1989, 2:36-43 2495982
82. Sheffner AL Medler EM Jacobs LW Sarett HP The in vitro reduction in viscosity of human tracheobronchial secretions by acetylcysteine Am Rev Respir Dis 1964, 90:721-729 14211458
83. Lawson D Saggers BA N.A.C. and antibiotics in cystic fibrosis BMJ 1965, 5430:317
84. Parry MF Neu HC Effect of N-acetylcysteine on antibiotic activity and bacterial growth in vitro J Clin Microbiol 1977, 5:58-61 274532 401831
85. Barton AD Aerosolized detergents and mucolytic agents in the treatment of stable chronic obstructive pulmonary disease Am Rev Respir Dis 1974, 110:104-110 4613216
86. Dueholm M Nielsen C Thorshauge H Evald T Hansen NC Madsen HD Maltbek N N-acetylcysteine by metered dose inhaler in the treatment of chronic bronchitis: A multi-centre study Respir Med 1992, 86:89-92 10.1016/ S0954-6111(06)80220-9 1615189
87. Dorsch W Auch E Powerlowicz P Adverse effects of acetylcysteine on human and guinea pig bronchial asthma in vivo and on human fibroblasts and leukocytes in vitro Int Arch Allergy Appl Immunol 1987, 82:33-39 2433224
88. Mant TG Tempowski JH Volans GN Talbot JC Adverse reactions to acetylcysteine and effects of overdose Br Med J (Clin Res Ed) 1984, 289(6439):217-9 1442311 6234965
89. Kory RC Hirsch SR Giraldo J Nebulization of N-acetylcysteine combined with a bronchodilator in patients with chronic bronchitis. A controlled study Dis Chest 1968, 54:504-509 10.1378/chest.54.6.504 4881157
90. Lourenco RV Cotromanes E Clinical aerosols II. Therapeutic aerosols Arch Intern Med 1982, 142:2299-2308 10.1001/archinte.142.13.2299 6816161
91. Lieberman J The appropriate use of mucolytic agents Am J Med 1970, 49:1-4 10.1016/S0002-9343(70)80107-3 4246985
92. Irwin RS Thomas HD Mucoid inpaction of the bronchus. Diagnosis and treatment Am Rev Respir Dis 1973, 108:955-959 4741888
93. Urschel HC Jr Paulson DL Shaw RR Mucoid impaction of the bronchi Ann Thorac Surg 1966, 2:1-16 5924799
94. Boogaard R de Jongste JC Merkus PJ Pharmacotherapy of impaired mucociliary clearance in non-CF pediatric lung disease. A review of the literature Pediatr Pulmonol 2007, 42:989-1001 10.1002/ppul.20693 17902149
95. Flume PA O'Sullivan BP Robinson KA Goss CH Mogayzel PJ Jr Willey-Courand DB Bujan J Finder J Lester M Quittell L Rosenblatt R Vender RL Hazle L Sabadosa K Marshall B Cystic Fibrosis Foundation, Pulmonary Therapies Committee Cystic fibrosis pulmonary guidelines: Chronic medications for maintenance of lung health Am J Respir Crit Care Med 2007, 176:957-969 10.1164/rccm.200705-664OC 17761616
96. Greally P Human recombinant DNase for mucus plugging in status asthmaticus Lancet 1995, 346:1423-1424 10.1016/S0140-6736(95)92436-1 7475833
97. Morris C Mullan B Use of dornase alfa in the management of ARDS Anaesthesia 2004, 59:1249 10.1111/j.1365-2044.2004.04018.x 15549997
98. Riethmueller J Borth-Bruhns T Kumpf M Vonthein R Wiskirchen J Stern M Hofbeck M Baden W Recombinant human deoxyribonuclease shortens ventilation time in young, mechanically ventilated children Pediatr Pulmonol 2006, 41(1):61-6 16265663 10.1002/ppul.20298
99. Frohock JI Wijkstrom-Frei C Salathe M Effects of albuterol enantiomers on ciliary beat frequency in ovine tracheal epithelial cells J Appl Physiol 2002, 92:2396-2402 12015353
100. Lafortuna CL Fazio F Acute effect of inhaled salbutamol on mucociliary clearance in health and chronic bronchitis Respiration 1984, 45:111-123 6729256
101. Svartengren K Philipson K Svartengren M Camner P Effect of adrenergic stimulation on clearance from small ciliated airways in healthy subjects Exp Lung Res 1998, 24:149-158 9555573
102. Beck-Sague C Banerjee S Jarvis WR Infectious diseases and mortality among US nursing home residents Am J Public Health 1993, 83:1739-1742 1694938 8259806
103. Kaneko K Milic-Emili J Dolovich MB Dawson A Bates DV Regional distribution of ventilation and perfusion as a function of body position J Appl Physiol 1966, 21:767-777 5912746
104. Raoof S Chowdhrey N Raoof S Feuerman M King A Sriraman R Khan FA Effect of combined kinetic therapy and percussion therapy on the resolution of atelectasis in critically ill patients Chest 1999, 115:1658-1666 10.1378/ chest.115.6.1658 10378565
105. deBoisblanc BP Castro M Everret B Grender J Walker CD Summer WR Effect of air-supported, continuous, postural oscillation on the risk of early ICU pneumonia in nontraumatic critical illness Chest 1993, 103:1543-1547 10.1378/chest.103.5.1543 8486041
106. Fink MP Helsmoortel CM Stein KL Lee PC Cohn SM The efficacy of an oscillating bed in the prevention of lower respiratory tract infection in critically ill victims of blunt trauma. A prospective study Chest 1990, 97:132-137 10.1378/chest.97.1.132 2295232
107. Kirschenbaum L Azzi E Sfeir T Tietjen P Astiz M Effect of continuous lateral rotational therapy on the prevalence of ventilator-associated pneumonia in patients requiring long-term ventilatory care Crit Care Med 2002, 30:1983-1986 10.1097/00003246-200209000-00006 12352030
108. Summer WR Curry P Haponik EF Nelson S Elston R Continuous mechanical turning of intensive care unit patients shortens length of stay in some diagnostic-related groups J Crit Care 1989, 4:45-53 10.1016/ 0883-9441(89)90091-9
109. Whiteman K Nachtmann L Kramer D Sereika S Bierman M Effects of continuous lateral rotation therapy on pulmonary complications in liver transplant patients Am J Crit Care 1995, 4:133-139 7749445
110. Gentilello L Thompson DA Tonnesen AS Hernandez D Kapadia AS Allen SJ Houtchens BA Miner ME Effect of a rotating bed on the incidence of pulmonary complications in critically ill patients Crit Care Med 1988, 16:783-786 10.1097/00003246-198808000-00010 3396372
111. Traver GA Tyler ML Hudson LD Sherrill DL Quan SF Continuous oscillation: outcome in critically ill patients J Crit Care 1995, 10:97-103 10.1016/ 0883-9441(95)90000-4 7496451
112. Kelley RE Bell LK Mason RL Cost analysis of kinetic therapy in the prevention of complications of stroke South Med J 1990, 83:433-434 2108501
113. Mackenzie CF Shin B Cardiorespiratory function before and after chest physiotherapy in mechanically ventilated patients with post-traumatic respiratory failure Crit Care Med 1985, 13:483-486 10.1097/ 00003246-198506000-00009 3888530
114. Marini JJ Pierson DJ Hudson LD Acute lobar atelectasis: A prospective comparison of fiberoptic bronchoscopy and respiratory therapy Am Rev Respir Dis 1979, 119:971-978 453712
115. Stiller K Geake T Taylor J Grant R Hall B Acute lobar atelectasis. A comparison of two chest physiotherapy regimens Chest 1990, 98:1336-1340 10.1378/chest.98.6.1336 2245671
116. MacLean D Drummond G Macpherson C McLaren G Prescott R Maximum expiratory airflow during chest physiotherapy on ventilated patients before and after the application of an abdominal binder Intensive Care Med 1989, 15:396-399 10.1007/BF00261500 2808898
117. Hall JC Tarala RA Tapper J Hall JL Prevention of respiratory complications after abdominal surgery: A randomised clinical trial BMJ 1996, 312:148-152 8563533
118. Lawrence VA Cornell JE Smetana GW Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: Systematic review for the American College of Physicians Ann Intern Med 2006, 144:596-608 16618957
119. Lederer DH Van de Water JM Indech RB Which deep breathing device should the postoperative patient use? Chest 1980, 77:610-613 10.1378/ chest.77.5.610 7363678
120. Van De Water JM Preoperative and postoperative techniques in the prevention of pulmonary complications Surg Clin North Am 1980, 60:1339-1348 7006121
121. Overend TJ Anderson CM Lucy SD Bhatia C Jonsson BI Timmermans C The effect of incentive spirometry on postoperative pulmonary complications: a systematic review Chest 2001, 120:971-978 10.1378/chest.120.3.971 11555536
122. Pasquina P Tramer MR Granier JM Walder B Respiratory physiotherapy to prevent pulmonary complications after abdominal surgery: A systematic review Chest 2006, 130:1887-1899 10.1378/chest.130.6.1887 17167013
123. Morran CG Finlay IG Mathieson M McKay AJ Wilson N McArdle CS Randomized controlled trial of physiotherapy for postoperative pulmonary complications Br J Anaesth 1983, 55:1113-1117 10.1093/bja/55.11.1113 6357256
124. Ntoumenopoulos G J PJ M M Cade JF Chest physiotherapy for the prevention of ventilator-associated pneumonia Intensive Care Med 2002, 28:850-856 10.1007/s00134-002-1342-2 12122521
125. Ntoumenopoulos G Gild A Cooper DJ The effect of manual lung hyperinflation and postural drainage on pulmonary complications in mechanically ventilated trauma patients Anaesth Intensive Care 1998, 26:492-496 9807602
126. Hammon WE Connors AF McCaffree DR Cardiac arrhythmias during postural drainage and chest percussion of critically ill patients Chest 1992, 102:1836-1841 10.1378/chest.102.6.1836 1280190
127. Selsby DS Chest physiotherapy BMJ 1989, 298:541-542 1835906 2495105
128. Templeton M Palazzo MG Chest physiotherapy prolongs duration of ventilation in the critically ill ventilated for more than 48 hours Intensive Care Med 2007, 33:1938-1945 10.1007/s00134-007-0762-4 17607561
129. Kang SW Kang YS Moon JH Yoo TW Assisted cough and pulmonary compliance in patients with Duchenne muscular dystrophy Yonsei Med J 2005, 46:233-238 15861496
130. Newth CJ Amsler B Anderson GP Morley J The effects of varying inflation and deflation pressures on the maximal expiratory deflation flow-volume relationship in anesthetized rhesus monkeys Am Rev Respir Dis 1991, 144:807-813 1928953
131. Marchant WA Fox R Postoperative use of a cough-assist device in avoiding prolonged intubation Br J Anaesth 2002, 89:644-647 10.1093/bja/aef227 12393370
132. Whitman J VanBeusekom R Olson S Worm M Indihar F Preliminary evaluation of high-frequency chest compression for secretion clearance in mechanically ventilated patients Respir Care 1993, 38:1081-1087 10145892
133. Laurikka JO Toivio I Tarkka MR Effects of a novel pneumatic vest on postoperative pain and lung function after coronary artery bypass grafting Scand Cardiovasc J 1998, 32:141-144 10.1080/14017439850140094 9764428
134. Tobin M Principles and Practices of Mechanical Ventilation New York: Mc-Graw Hill 2 2006.
135. Kerwin AJ Croce MA Timmons SD Maxwell RA Malhotra AK Fabian TC Effects of fiberoptic bronchoscopy on intracranial pressure in patients with brain injury: A prospective clinical study J Trauma 2000, 48:878-882 10823531
136. Lindholm CE Ollman B Snyder JV Millen EG Grenvik A Cardiorespiratory effects of flexible fiberoptic bronchoscopy in critically ill patients Chest 1978, 74:362-368 10.1378/chest.74.4.362 699643
137. Snow N Lucas AE Bronchoscopy in the critically ill surgical patient Am Surg 1984, 50:441-445 6465691
138. Trouillet JL Guiguet M Gibert C Fagon JY Dreyfuss D Blanchet F Chastre J Fiberoptic bronchoscopy in ventilated patients. Evaluation of cardiopulmonary risk under midazolam sedation Chest 1990, 97:927-933 10.1378/chest.97.4.927 2108848
139. Kreider ME Lipson DA Bronchoscopy for atelectasis in the ICU: A case report and review of the literature Chest 2003, 124:344-350 10.1378/ chest.124.1.344 12853543
140. Lindholm CE Ollman B Snyder J Millen E Grenvik A Flexible fiberoptic bronchoscopy in critical care medicine. Diagnosis, therapy and complications Crit Care Med 1974, 2:250-261 4616797
141. Olopade CO Prakash UB Bronchoscopy in the critical-care unit Mayo Clin Proc 1989, 64:1255-1263 2687588
142. Stevens RP Lillington GA Parsons GH Fiberoptic bronchoscopy in the intensive care unit Heart Lung 1981, 10:1037-1045 6913568
143. Weinstein HJ Bone RC Ruth WE Pulmonary lavage in patients treated with mechanical ventilation Chest 1977, 72:583-587 10.1378/chest.72.5.583 913135