tailieunhanh - Báo cáo y học: "Paradoxical ventilator associated pneumonia incidences among selective digestive decontamination studies versus other studies of mechanically ventilated patients: benchmarking the evidence base"

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: Paradoxical ventilator associated pneumonia incidences among selective digestive decontamination studies versus other studies of mechanically ventilated patients: benchmarking the evidence base. | Hurley Critical Care 2011 15 R7 http content 15 1 R7 KS CRITICAL CARE RESEARCH Open Access Paradoxical ventilator associated pneumonia incidences among selective digestive decontamination studies versus other studies of mechanically ventilated patients benchmarking the evidence base James C Hurley1 2 Abstract Introduction Selective digestive decontamination SDD appears to have a more compelling evidence base than non-antimicrobial methods for the prevention of ventilator associated pneumonia VAP . However the striking variability in ventilator associated pneumonia-incidence proportion VAP-IP among the SDD studies remains unexplained and a postulated contextual effect remains untested for. Methods Nine reviews were used to source 45 observational benchmark groups and 137 component control and intervention groups of studies of SDD and studies of three non-antimicrobial methods of VAP prevention. The logit VAP-IP data were summarized by meta-analysis using random effects methods and the associated heterogeneity tau2 was measured. As group level predictors of logit VAP-IP the mode of VAP diagnosis proportion of trauma admissions the proportion receiving prolonged ventilation and the intervention method under study were examined in meta-regression models containing the benchmark groups together with either the control models 1 to 3 or intervention models 4 to 6 groups of the prevention studies. Results The VAP-IP benchmark derived here is 95 confidence interval 95 CI to tau2 whereas the mean VAP-IP of control groups from studies of SDD and of non-antimicrobial methods is to tau2 versus to tau2 respectively P . The disparity between the benchmark groups and the control groups of the SDD studies which was most apparent for the highest quality studies could not be explained in the meta-regression models after adjusting for various group level factors. The mean VAP-IP 95 CI of intervention groups