Evidence-based algorithms for diagnosing and treating ventilator-associated pneumonia

Journal of Hospital Medicine

Volumn 3, Issue 5, 2008, Pages 409-422

  Wall, Richard J ^a   Wesley Ely, E ^b,c   Talbot, Thomas R ^c   Weinger, Matthew B ^b,d   Williams, Mark V ^e   Reischel, Joan ^f   Hayley Burgess, L ^g   Englebright, Jane ^g   Dittus, Robert S ^b,c   Speroff, Theodore ^b,c   Deshpande, Jayant K ^c  

^a Valley Medical Center   (United States)

^b VETERANS AFFAIRS MEDICAL CENTER   (United States)

^c VANDERBILT UNIVERSITY SCHOOL OF MEDICINE   (United States)

^d VANDERBILT UNIVERSITY MEDICAL CENTER   (United States)

^e NORTHWESTERN UNIVERSITY   (United States)

^f Medical Center of Aurora   (United States)

^g HOSPITAL CORPORATION OF AMERICA   (United States)

Author keywords

Critical care; Health care associated infection; Pneumonia diagnosis; Quality of health care; Ventilator associated pneumonia

Indexed keywords

ANTIBIOTIC AGENT; BETA LACTAM ANTIBIOTIC; LINEZOLID; QUINOLINE DERIVED ANTIINFECTIVE AGENT; VANCOMYCIN;

ALGORITHM; ARTIFICIAL VENTILATION; CATHETER INFECTION; CONSENSUS; CRITICALLY ILL PATIENT; EVIDENCE BASED PRACTICE; HOSPITAL INFECTION; HOSPITALIZED CHILD; HUMAN; IMMUNOCOMPROMISED PATIENT; INTENSIVE CARE; INTENSIVE CARE UNIT; MEDICAL SPECIALIST; MEDICAL STAFF; NURSE; PHARMACIST; PRACTICE GUIDELINE; PRIORITY JOURNAL; REVIEW; SEPSIS; VENTILATOR ASSOCIATED PNEUMONIA; EVIDENCE BASED MEDICINE; HOSPITAL; STANDARD; VENTILATOR;

ALGORITHMS; EVIDENCE-BASED MEDICINE; HOSPITALS, PROPRIETARY; HUMANS; INTENSIVE CARE UNITS; PNEUMONIA, VENTILATOR-ASSOCIATED; PRACTICE GUIDELINES AS TOPIC; VENTILATORS, MECHANICAL;

EID: 56149105151     PISSN: 15535592     EISSN: 15535606     Source Type: Journal    
DOI: 10.1002/jhm.317     Document Type: Review

References (122)

1. Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in combined medical-surgical intensive care units in the United States. Infect Control Hosp Epidemiol. 2000;21:510-515.
2. Centers for Disease Control and Prevention. Guidelines for preventing health-care - associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep. 2004;53:1-36.
3. Centers for Disease Control and Prevention. The National Healthcare Safety Network (NHSN) manual: patient safety component protocol (updated May 24, 2007). Available at: http://www.cdc.gov/ncidod/dhqp/pdf/nhsn/ NHSN_Manual_Patient_Safety_Protocol052407.pdf.. Accessed October 1, 2007.
4. Warren DK, Shukla SJ, Olsen MA, et al. Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center. Crit Care Med. 2003;31:1312-1317.
5. ATS. Guidelines for the management of adults with hospital -acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171: 388-416.
6. Boyce JM, Potter-Bynoe G, Dziobek L, Solomon SL. Nosocomial pneumonia in Medicare patients. Hospital costs and reimbursement patterns under the prospective payment system. Arch Intern Med. 1991;151:1109-1114.
7. van Nieuwenhoven CA, Buskens E, Bergmans DC, van Tiel 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.
8. Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med. 2005;33:2184-2193.
9. Solomkin JS. Cost-effectiveness issues in ventilator-associated pneumonia. Respir Care. 2005;50:956-963; discussion 963-964.
10. Fagon JY. Diagnosis and treatment of ventilator-associated pneumonia: fiberoptic bronchoscopy with bronchoalveolar lavage is essential. Semin Respir Crit Care Med. 2006; 27:34-44.
11. Heyland D, Dodek P, Muscedere J, Day A. A randomized trial of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med. 2006;355:2619-2630.
12. Kollef MH, Morrow LE, Niederman MS, et al. Clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia. Chest. 2006;129: 1210-1218.
13. Sierra R, Benitez E, Leon C, Rello J. Prevention and diagnosis of ventilator-associated pneumonia: a survey on current practices in Southern Spanish ICUs. Chest. 2005; 128:1667-1673.
14. Cabana MD, Rand CS, Powe NR, et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282:1458-1465.
15. Rello J, Lorente C, Bodi M, Diaz E, Ricart M, Kollef MH. Why do physicians not follow evidence-based guidelines for preventing ventilator-associated pneumonia?: a survey based on the opinions of an international panel of intensivists. Chest. 2002;122:656-661.
16. Spring B, Pagoto S, Kaufmann PG, et al. Invitation to a dialogue between researchers and clinicians about evidence-based behavioral medicine. Ann Behav Med. 2005; 30:125-137.
17. Berwick DM, James B, Coye MJ. Connections between quality measurement and improvement. Med Care. 2003; 41:130-138.
18. Grilli R, Magrini N, Penna A, Mora G, Liberati A. Practice guidelines developed by specialty societies: the need for a critical appraisal. Lancet. 2000;355:103-106.
19. Agency for Healthcare Research and Quality (AHRQ). Partnerships in Implementing Patient Safety. Online at http://www.ahrq.gov/qua/pips.htm. Accessed March 1, 2007.
20. Flabouris A, Myburgh J. The utility of open lung biopsy in patients requiring mechanical ventilation. Chest. 1999;115: 811-817.
21. Park DR. The microbiology of ventilator-associated pneumonia. Respir Care. 2005;50:742-763; discussion 763-765.
22. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002;165:867-903.
23. Gaynes R, Edwards JR. Overview of nosocomial infections caused by gram-negative bacilli. Clin Infect Dis. 2005;41: 848-854.
24. Fridkin SK. Increasing prevalence of antimicrobial resistance in intensive care units. Crit Care Med. 2001;29: N64-N68.
25. Comoes A Figliolini C, Trouillet JL, et al. Incidence and outcome of polymicrobial ventilator-associated pneumonia. Chest. 2002;121:1618-1623.
26. Stott DJ, Kerr G, Carman WF. Nosocomial transmission of influenza. Occup Med (Lond). 2002;52:249-253.
27. Slinger R, Dennis P. Nosocomial influenza at a Canadian pediatric hospital from 1995 to 1999: opportunities for prevention. Infect Control Hosp, Epidemiol. 2002;23: 627-629.
28. Hall CB, Douglas RG, Jr. Nosocomial influenza infection as a cause of intercurrent fevers in infants. Pediatrics. 1975;55:673-677.
29. Barlow G, Nathwani D. Nosocomial influenza infection. Lancet. 2000;355:1187.
30. Van Voris LP, Belshe RB, Shaffer JL. Nosocomial influenza B virus infection in the elderly. Ann Intern Med. 1982;96: 153-158.
31. Talbot TR, Bradley SE, Cosgrove SE, Ruef C, Siegel JD, Weber DJ. Influenza vaccination of healthcare workers and vaccine allocation for healthcare workers during vaccine shortages. Infect Control Hosp Epidemiol. 2005;26: 882-890.
32. Bruynseels P, Jorens PG, Demey HE, et al. Herpes simplex virus in the respiratory tract of critical care patients: a prospective study. Lancet. 2003;362:1536-1541.
33. el-Ebiary M, Torres A, Eahregas N. et al. Significance of the isolation of Candida species from respiratory samples in critically ill, non-neutropenic patients. An immediate postmortem histologic study. Am J Respir Crit Care Med. 1997;156:583-590.
34. Bello J, Esandi ME, Diaz E, Mariscal D, Gallego M, Valles J. The role of Candida sp isolated from bronchoscopic samples in nonneutropenic patients. Chest. 1998;114:146-149.
35. Hogan DA, Kolter R. Pseudomonas-Candida interactions: an ecological role for virulence factors. Science. 2002;296: 2229-2232.
36. Azoulay E, Timsit J-F, Tafflet M, et al. Candida colonization of the respiratory tract and subsequent pseudomonas ventilator-associated pneumonia. Chest. 2006;129: 110-117.
37. Nseir S, Jozefowicz E, Cavestri B, et al. Impact of antifungal treatment on Candida-Pseudomonas interaction: a preliminary retrospective case-control study. Intensive Care Med. 2007;33:137-142.
38. Shorr AF, Susla GM, O'Grady NP. Pulmonary infiltrates in the non-HIV-infected immunocompromised patient: etiologies, diagnostic strategies, and outcomes. Chest. 2004; 125:260-271.
39. Kotloff RM, Ahya VN, Crawford SW. Pulmonary complications of solid organ and hematopoietic stem cell transplantation. Am J Respir Crit Care Med. 2004;170: 22-48.
40. Patriarca F, Skert C, Sperotto A, et al. Incidence, outcome, and risk factors of late-onset noninfectious pulmonary complications after unrelated donor stem cell transplantation. Bone Marrow Transplant. 2004;33:751-758.
41. Fishman JA, Rubin RH. Infection in organ-transplant recipients. N Engl J Med. 1998;338:1741-1751.
42. Cordero L, Ayers LW, Miller RR, Seguin JH, Coley BD. Surveillance of ventilator-associated pneumonia in very-low-birth-weight infants. Am J Infect Control. 2002;30: 32-39.
43. Apisamthanarak A, Holzmann-Pazgal G, Hamvas A, Olsen MA, Fraser VJ. Ventilator-associated pneumonia in extremely preterm neonates in a neonatal intensive care unit: characteristics, risk factors, and outcomes. Pediatrics. 2003;112:1283-1289.
44. Suara RO, Young M, Reeves I. Risk factors for nosocomial-infection in a high-risk nursery, Infect Control Hosp Epidemiol. 2000;21:250-251.
45. Elward AM. Pediatric ventilator-associated pneumonia. Pediatr Infect Dis J. 2003;22:445-446.
46. Elward AM, Warren DK, Fraser VJ. Ventilator-associated pneumonia in pediatric intensive care unit patients: risk factors and outcomes. Pediatrics. 2002;109:758-764.
47. Trouillet JL, Chastre J, Vuagnat A, et al. Ventilator-associated. pneumonia caused by potentially drug-resistant bacteria. Am J Respir Crit Care Med. 1998;157: 531-539.
48. Baker AM, Meredith JW, Haponik EF. Pneumonia in intubated trauma patients. Microbiology and outcomes. Am J Respir Crit Care Med. 1996;153:343-349.
49. Rello J, Ricart M, Ausina V, Net A, Prats G. Pneumonia due to Haemophilus influenzae among mechanically ventilated patients. Incidence, outcome, and risk factors. Chest. 1992;102:1562-1565.
50. Giantsou E, Liratzopoulos N, Efraimidou E, et al. Both early-onset and late-onset ventilator-associated pneumonia are caused mainly by potentially multiresistant bacteria. Intensive Care Med 2005;31:1488-1494.
51. Ibrahim EH, Ward S, Sherman G, Kollef MH. A comparative analysis of patients with early-onset vs late-onset nosocomial pneumonia in the ICU setting. Chest. 2000; 117:1434-1442.
52. Baughman RP. Diagnosis of ventilator-associated pneumonia. Curr Opin Crit Care. 2003;9:397-402.
53. Mabie M, Wunderink RG. Use and limitations of clinical and radiologic diagnosis of pneumonia. Semin Respir Infect. 2003;18:72-79.
54. Luna CM, Videla A, Mattera J, et al. Blood cultures have limited value in predicting severity of illness and as a diagnostic tool in ventilator-associated pneumonia. Chest. 1999;116:1075-1084.
55. Chastre J, Combes A, Luyt CE. The invasive (quantitative) diagnosis of ventilator-associated pneumonia. Respir Care. 2005;50:797-807.
56. Shorr AF, Sherner JH, Jackson WL, Kollef MH. Invasive approaches to the diagnosis of ventilator-associated pneumonia: a meta-analysis. Crit Care Med. 2005;33:46-53.
57. Niederman MS. The clinical diagnosis of ventilator-associated pneumonia. Respir Care. 2005;50:788-796; discussion 807-812.
58. Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic "blind" bronchoalveolar lavage fluid. Am Rev Respir Dis. 1991;143:1121-1129.
59. Fartoukh M, Maitre B, Honore S, Cerf C, Zahar JR, Brun-Buisson C. Diagnosing pneumonia during mechanical ventilation: the clinical pulmonary infection score revisited. Am J Respir Crit Care Med. 2003;168:173-179.
60. Flanagan PG, Findlay GP, Magee JT, Ionescu A, Barnes RA, Smithies M. The diagnosis of ventilator-associated pneumonia using non-bronchoscopic, non-directed lung lavages. Intensive Care Med. 2000;26:20-30.
61. Schurink CA, Van Nieuwenhoven CA, Jacobs JA, et al. Clinical pulmonary infection score for ventilator-associated pneumonia: accuracy and inter-observer variability. Intensive Care Med. 2004;30:217-224.
62. Micek ST, Ward S, Fraser VJ, Kollef MH. A randomized controlled trial of an antibiotic discontinuation policy for clinically suspected ventilator-associated pneumonia. Chest. 2004;125:1791-1799.
63. Michel F, Franceschini B, Berger P, et al. Early antibiotic treatment for BAL-confirmed ventilator-associated pneumonia: a role for routine endotracheal aspirate cultures. Chest. 2005;127:589-597.
64. Singh N, Rogers P, Atwood CW, Wagener MM, Yu VL. Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. A proposed solution for indiscriminate antibiotic prescription. Am J Respir Crit Care Med. 2000;162: 505-511.
65. Ibrahim EH, Ward S, Sherman G, Schaiff R, Fraser VJ, Kollef MH. Experience with a clinical guideline for the treatment of ventilator-associated pneumonia. Crit Care Med. 2001;29:1109-1115.
66. Sanchez-Nieto JM, Torres A, Garcia-Cordoba F, et al. Impact of invasive and noninvasive quantitative culture sampling on outcome of ventilator-associated pneumonia: a pilot study. Am J Respir Crit Care Med. 1998;157:371-376.
67. Ruiz M, Torres A, Ewig S, et al. Noninvasive versus invasive microbial investigation in ventilator-associated pneumonia: evaluation of outcome. Am J Respir Crit Care Med. 2000;162:119-125.
68. Sole Violan J, Fernandez JA, Benitez AB, Cardenosa Cendrero JA, Rodriguez de Castro F. Impact of quantitative invasive diagnostic techniques in the management and outcome of mechanically ventilated patients with suspected pneumonia. Crit Care Med. 2000;28:2737-2741.
69. Fagon JY, Chastre J, Wolff M, et al. Invasive and noninvasive strategies for management of suspected ventilator-associated pneumonia. A randomized trial. Ann Intern Med. 2000;132:621-630.
70. Chastre J, Combes A, Luyt CE. Expert discussion: The invasive (quantitative) diagnosis of ventilator-associated pneumonia. Respir Care. 2005;50:807-812.
71. Luna CM, Vujacich P, Niederman MS, et al. Impact of BAL data on the therapy and outcome of ventilator-associated pneumonia. Chest. 1997;111:676-685.
72. Dupont H, Mentec H, Sollet JP, Bleichner G. Impact of appropriateness of initial antibiotic therapy on the outcome of ventilator-associated pneumonia. Intensive Care Med. 2001;27:355-362.
73. Iregui M, Ward S, Sherman G, Fraser VJ, Kollef MH. Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia. Chest. 2002;122:262-268.
74. Luna CM, Aruj P, Niederman MS, et al. Appropriateness and delay to initiate therapy in ventilator-associated pneumonia. Eur Respir J. 2006;27:158-164.
75. Kollef MH. The importance of appropriate initial antibiotic therapy for hospital-acquired infections. Am J Med. 2003;115:582-584.
76. Souweine B, Veber B, Bedos JP, et al. Diagnostic accuracy of protected specimen brush and bronchoalveolar lavage in nosocomial pneumonia: impact of previous antimicrobial treatments. Crit Care Med. 1998;26:236-244.
77. Rello J, Vidaur L, Sandiumenge A, et al. De-escalation therapy in ventilator-associated pneumonia. Crit Care Med. 2004;32:2183-2190.
78. Chastre J, Wolff M, Fagon JY, et al. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA. 2003;290: 2588-2598.
79. Niederman MS. De-escalation therapy in ventilator-associated pneumonia. Curr Opin Crit Care. 2006;12: 452-457.
80. Dodek P, Keenan S, Cook D, et al. Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia. Ann Intern Med. 2004;141: 305-313.
81. Chastre J. Conference summary: ventilator-associated pneumonia. Respir Care. 2005;50:975-983.
82. Collard HR, Saint S, Matthay MA. Prevention of ventilator-associated pneumonia: an evidence-based systematic review. Ann Intern Med. 2003;138:494-501.
83. Kollef MH. The prevention of ventilator-associated pneumonia. N Engl J Med. 1999;340:627-634.
84. Weinstein RA. Epidemiology and control of nosocomial infections in adult intensive care units. Am J Med. 1991;91:179S-184S.
85. Pittet D, Hugonnet S, Harbarth S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet. 2000; 356:1307-1312.
86. Torres A, Gatell JM, Aznar E, et al. Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation. Am J Respir Crit Care Med. 1995; 152:137-41.
87. Celis R, Torres A, Gatell JM, Almela M, Rodriguez-Roisin R, Agusti-Vidal A. Nosocomial pneumonia. A multivariate analysis of risk and prognosis. Chest. 1988;93:318-324.
88. Girou E, Schortgen F, Delclaux C, et al. Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients. JAMA. 2000;284: 2361-2367.
89. Rouby JJ, Laurent P, Gosnach M, et al. Risk factors and clinical relevance of nosocomial maxillary sinusitis in the critically ill. Am J Respir Crit Care Med. 1994;150: 776-783.
90. Ramirez P, Ferrer M, Torres A. Prevention measures for ventilator-associated pneumonia: a new focus on the endotracheal tube. Curr Opin Infect Dis. 2007;20: 190-197.
91. Smulders K, van der Hoeven 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.
92. Valles J, Artigas A, Rello J, et al. Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia. Ann Intern Med. 1995;122:179-186.
93. Rello J, Sonora R, Jubert P, Artigas A, Rue M, Valles J. Pneumonia in intubated patients: role of respiratory airway care. Am J Respir Crit Care Med. 1996;154:111-115.
94. Kollef MH, Shapiro SD, Fraser VJ, et al. Mechanical ventilation with or without 7-day circuit changes. A randomized controlled trial. Ann Intern Med. 1995;123:168-174.
95. Craven DE, Goularte TA, Make BJ. Contaminated condensate in mechanical ventilator circuits. A risk factor for nosocomial pneumonia? Am Rev Respir Dis. 1984;129: 625-628.
96. Harbarth S, Sudre P, Dharan S, Cadenas M, Pittet D. Outbreak of Enterobacter cloacae related to understaffing, overcrowding, and poor hygiene practices. Infect Control Hosp. Epidemiol. 1999; 20:598-603.
97. Hugonnet S, Harbarth S, Sax H, Duncan RA, Pittet D. Nursing resources: a major determinant of nosocomial infection? Curr Opin Infect Dis. 2004;17:329-333.
98. Needleman J, Buerhaus P, Mattke S, Stewart M, Zelevinsky K. Nurse-staffing levels and the quality of care in hospitals. N Engl J Med. 2002;346:1715-1722.
99. Ely EW, Baker AM, Dunagan DP, et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med. 1996; 335:1864-1869.
100. Kollef MH, Shapiro SD, Silver P, et al. A randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation. Crit Care Med. 1997;25:567-574.
101. Kress JP, Pohlman AS, O'Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000; 342:1471-1477.
102. Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogue S, Ferrer M. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet. 1999;354:1851-1858.
103. Ibrahim EH, Mehringer L, Prentice D, et al. Early versus late enteral feeding of mechanically ventilated patients: results of a clinical trial. JPEN J Parenter Enteral Nutr. 2002;26:174-181.
104. Heyland DK, Drover JW, Dhaliwal R, Greenwood J. Optimizing the benefits and minimizing the risks of enteral nutrition in the critically ill: role of small bowel feeding. JPEN J Parenter Enteral Nutr. 2002;26:S51-S55; discussion S56-S57.
105. Chan EY, Ruest A, Meade MO, Cook DJ. Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis. BMJ. 2007;334:889.
106. Chlebicki MP, Safdar N. Topical chlorhexidine for prevention of ventilator-associated pneumonia: a meta-analysis. Crit Care Med. 2007;35:595-602.
107. Koeman M, van der Ven AJ, Hak E, et al. Oral decontamination with chlorhexidine reduces the incidence of ventilator-associated pneumonia. Am J Respir Crit Care Med. 2006;173:1348-1355.
108. Kola A, Gastmeier P. Efficacy of oral chlorhexidine in preventing lower respiratory tract infections. Meta-analysis of randomized controlled trials. J Hosp Infect. 2007;66:207-216.
109. van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001;345:1359-1367.
110. Shorr AF, Duh MS, Kelly KM, Kollef MH. Red blood cell transfusion and ventilator-associated pneumonia: A potential link? Crit Care Med. 2004;32:666-674.
111. Cook D, Guyatt G, Marshall J, et al. A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. Canadian Critical Care Trials Group. N Engl J Med. 1998;338:791-797.
112. Driks MR, Craven DE, Celli BR, et al. Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers. The role of gastric colonization. N Engl J Med. 1987;317: 1376-1382.
113. Liberati A, D'Amico R, Pifferi, Torri V, Brazzi L. Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care. Cochrane Database Syst Rev. 2004:CD000022.
114. Bonten MJ, Krueger WA. Selective decontamination of the digestive tract: cumulating evidence, at last? Semin Respir Crit Care Med. 2006;27:18-22.
115. Sirvent JM, Torres A, El-Ebiary M, Castro P, de Batlle J, Bonet A. Protective effect of intravenously administered cefuroxime against nosocomial pneumonia in patients with structural coma. Am J Respir Crit Care Med. 1997; 155:1729-1734.
116. Hoth JJ, Franklin GA, Stassen NA, Girard SM, Rodriguez RJ, Rodriguez JL. Prophylactic antibiotics adversely affect nosocomial pneumonia in trauma patients. J Trauma. 2003;55:249-254.
117. Nelson LD, Choi SC. Kinetic therapy in critically ill trauma patients. Clin Intensive Care. 1992;3:248-252.
118. Traver GA, Tyler ML, Hudson LD, Sherrill DL, Quan SF. Continuous oscillation: outcome in critically ill patients. J Crit Care. 1995;10:97-103.
119. Delaney A, Gray H, Laupland KB, Zuege DJ. Kinetic bed therapy to prevent nosocomial pneumonia in mechanically ventilated patients: a systematic review and metaanalysis. Crit Care. 2006;10:R70.
120. Berwick DM, Calkins DR, McCannon CJ, Hackbarth AD. The 100,000 lives campaign: setting a goal and a deadline for improving health care quality. JAMA. 2006;295: 324-327.
121. Zap the VAP. Available at: http://www.zapthevap.com. Accessed March 1, 2007.
122. Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001;344:665-671.