Prevention of Ventilator-Associated Pneumonia
Authors: Jean-Damien Ricard, Didier Dreyfuss
Journal: Annals of Internal Medicine (2004)

Letters16 March 2004Prevention of Ventilator-Associated PneumoniaJean-Damien Ricard, MD, PhD and Didier Dreyfuss, MDJean-Damien Ricard, MD, PhDFrom Louis Mourier Hospital, 92700 Colombes, France.Search for more papers by this author and Didier Dreyfuss, MDFrom Louis Mourier Hospital, 92700 Colombes, France.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-140-6-200403160-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Collard and colleagues' review (1) on the prevention of ventilator-associated pneumonia illustrates the failure of evidence-based medicine. First, concerning stress ulcer prophylaxis, the authors' recommendation to use sucralfate rather than H2-antagonists (on the basis of lower rates of pneumonia with sucralfate [2, 3]) since neither sucralfate nor H2-antagonists prevent gastrointestinal bleeding. The authors' choice was based on their preference rather than on evidence-based medicine.Second, the authors' interpretation of the evidence is questionable: They stated that aspiration of subglottic secretions is most effective in patients who require prolonged mechanical ventilation. However, 2 of the 3 trials cited ...References1. Collard HR, Saint S, Matthay MA. Prevention of ventilator-associated pneumonia: an evidence-based systematic review. Ann Intern Med. 2003;138:494-501. [PMID: 12639084] LinkGoogle Scholar2. Cook DJ, Reeve BK, Guyatt GH, Heyland DK, Griffith LE, Buckingham L, et al . Stress ulcer prophylaxis in critically ill patients. Resolving discordant meta-analyses. JAMA. 1996;275:308-14. [PMID: 8544272] CrossrefMedlineGoogle Scholar3. Messori A, Trippoli S, Vaiani M, Gorini M, Corrado A. Bleeding and pneumonia in intensive care patients given ranitidine and sucralfate for prevention of stress ulcer: meta-analysis of randomised controlled trials. BMJ. 2000;321:1103-6. [PMID: 11061729] CrossrefMedlineGoogle Scholar4. Djedaini K, Billiard M, Mier L, Le Bourdelles G, Brun P, Markowicz P, et al . Changing heat and moisture exchangers every 48 hours rather than 24 hours does not affect their efficacy and the incidence of nosocomial pneumonia. Am J Respir Crit Care Med. 1995;152:1562-9. [PMID: 7582295] CrossrefMedlineGoogle Scholar5. Davis K, Evans SL, Campbell RS, Johannigman JA, Luchette FA, Porembka DT, et al . Prolonged use of heat and moisture exchangers does not affect device efficiency or frequency rate of nosocomial pneumonia. Crit Care Med. 2000;28:1412-8. [PMID: 10834688] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Jean-Damien Ricard, MD, PhD; Didier Dreyfuss, MDAffiliations: From Louis Mourier Hospital, 92700 Colombes, France. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPrevention of Ventilator-Associated Pneumonia: An Evidence-Based Systematic Review Harold R. Collard , Sanjay Saint , and Michael A. Matthay Prevention of Ventilator-Associated Pneumonia Harold R. Collard , Sanjay Saint , and Michael A. Matthay Metrics Cited byHumidification Devices and Ventilator-Associated Pneumonia: Current Recommendations on Respiratory EquipmentGold standard for humidification: Heat and moisture exchangers, heated humidifiers, or both?*Gold standard for humidification: Heat and moisture exchangers, heated humidifiers, or both?* 16 March 2004Volume 140, Issue 6Page: 486KeywordsEvidence based medicineFearGastrointestinal tractHemorrhageNoninvasive ventilationPneumoniaProphylaxisUlcersVentilator associated pneumoniaVentilators ePublished: 16 March 2004 Issue Published: 16 March 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...