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Báo cáo y học: "The paradox of ventilator-associated pneumonia prevention measures"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: The paradox of ventilator-associated pneumonia prevention measures. | Available online http ccforum.eom content 13 5 315 Viewpoint The paradox of ventilator-associated pneumonia prevention measures Michael Klompas1 2 infection Control Department Brigham and Women s Hospital and Harvard Medical School 75 Francis Street Boston MA 02115 USA 2Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care 133 Brookline Avenue Boston MA 02215 USA Corresponding author Michael Klompas mklompas@partners.org Published 15 October 2009 This article is online at http ccforum.com content 13 5 315 2009 BioMed Central Ltd Critical Care 2009 13 315 doi 10.1186 cc8036 Abstract There is a striking paradox in the literature supporting high-profile measures to reduce ventilator-associated pneumonia VAP many studies show significant reductions in VAP rates but almost none show any impact on patients duration of mechanical ventilation length of stay in the intensive care unit and hospital or mortality. The paradox is largely attributable to lack of specificity in the VAP definition. The clinical and microbiological criteria for VAP capture a population of patients with an array of conditions that range from serious to benign. Many of the benign events are manifestations of bacterial colonization superimposed upon pulmonary edema atelectasis or other non-infectious processes. VAP prevention measures that work by decreasing bacterial colonization preferentially lower the frequency of these mislabelled more benign events. In addition misclassification obscures detection of an impact of prevention measures on bona fide pneumonias. Together these effects create the possibility of the paradox where a prevention measure may have a large impact on VAP rates but minimal impact on patients outcomes. The paradox makes changes in VAP rates alone an unreliable measure of whether VAP prevention measures are truly beneficial to patients and behooves us to measure their impact on patient outcomes before advocating their adoption. The paradox .