Prevention of ventilator-associated pneumonia: analysis of studies published since 2004.

As the most recent guidelines for the prevention of ventilator-associated pneumonia (VAP) were published four years ago, we have conducted a systematic review to discover whether the recently published articles should further influence existing guidelines. Articles published since 2004 dealing with infection control measures for prevention of VAP were gathered and evaluated in order to identify evidence for the possible modification of routine practice. Special emphasis was placed on randomized controlled trials (RCTs), meta-analyses or systematic reviews and studies applying multi-module interventions. A total of 15 RCTs and seven meta-analyses or systematic reviews were found. In addition to these, five cohort studies were identified where multi-module programmes were introduced for reducing VAP rates. The data lead to the conclusion that topical use of chlorhexidine for oral care is beneficial and subglottic secretion drainage may lead to delayed onset of VAP. The remaining studies had only a minor influence on existing guidelines for the prevention of VAP and confirmed the earlier recommendations in several points. However, the studies investigating multi-module programmes led to a substantial reduction of VAP of between 31 and 57%. The data show that many VAP cases are preventable and that there is room for improvement in many institutions. Often simple interventions are useful for the reduction of VAP rates, for which the best chances appeared to be the application of multi-module programmes. On average a reduction of more than 40% seems to be possible.