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Prevention measures for ventilator-associated pneumonia: a new focus on the endotracheal tube

Ramirez, Paulaa; Ferrer, Miquelb; Torres, Antonib

Current Opinion in Infectious Diseases: April 2007 - Volume 20 - Issue 2 - p 190–197
doi: 10.1097/QCO.0b013e328014daac
Respiratory infections
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Purpose of review The aim of this article is to analyze the aspects related to the endotracheal tube which may influence the development of ventilator-associated pneumonia and to review the possible measures of prevention.

Recent findings The endotracheal tube participates in the pathogenesis of ventilator-associated pneumonia by the elimination of natural defense mechanisms, thereby allowing the entry of bacteria by the aspiration of subglottic secretions or the formation of biofilm on the endotracheal tube. The preventive measures of ventilator-associated pneumonia related to the endotracheal tube include these two mechanisms. It has been suggested that substitution of the endotracheal tube by early tracheostomy may reduce the risk of ventilator-associated pneumonia.

Summary Aspiration of the subglottic secretions seems to be an effective measure with little risk; decontamination or exhaustive control of the sealing of the cuff has not demonstrated a positive risk/benefit balance. The causal relationship between biofilm and ventilator-associated pneumonia has not been clearly established. Treatment of the biofilm with antibiotics, changes in the composition of the endotracheal tube or mechanical cleansing have achieved a reduction or elimination of the biofilm but their effect on the incidence of ventilator-associated pneumonia has not been studied. The benefit of early tracheostomy in reducing ventilator-associated pneumonia is still controversial.

aIntensive Care Unit, Hospital Universitario La Fe, Valencia

bRespiratory Intensive and Intermediate Care Unit, Department of Pneumology, Clinical Institute of the Thorax, Hospital Clinic, Barcelona, Spain

Correspondence to Antoni Torres, MD, Servei de Pneumologia, Institut Clínic del Tòrax, Hospital Clinic, Villarroel, 170. E-08036 Barcelona, Spain Tel/fax: +34 93 227 55 49; e-mail: atorres@ub.edu

© 2007 Lippincott Williams & Wilkins, Inc.