Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Risk of ventilator-associated pneumonia cut significantly

19.06.2006
Researchers found that administering the topical antiseptic chlorhexidine to critically ill patients on mechanical ventilation greatly decreased their daily risk of acquiring deadly hospital-related ventilator-associated pneumonia.

The results appeared in the second issue for June 2006 of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.

Mirelle Koeman, M.D., Ph.D., of the Department of Emergency Medicine and Infectious Diseases at the University Medical Center Utrecht in the Netherlands, and 13 associates used chlorhexidine as an oral decontaminant paste to treat 127 intubated ventilated patients. The investigators treated a separate group of 128 ventilated patients with a paste composed of chlorhexidine and the antibiotic colistin. A third group of 130 ventilated patients were given a placebo paste.

In comparison to the placebo, the chlorhexidine paste reduced the risk of ventilator-associated pneumonia by 65 percent and the chlorhexidine/colistin combination cut the risk by 55 percent.

All 385 patients who were enrolled consecutively in the study needed mechanical ventilation for 48 hours or more at two university hospitals and three general hospitals in the Netherlands.

According to the authors, ventilator-associated pneumonia is second only to urinary infection as a hospital-acquired illness. The disease affects 27 percent of all critically-ill ventilated patients. Crude mortality rates from ventilator-associated pneumonia range from 20 to 60 percent, and resulting health care costs can be anywhere from $12,000 to $40,000 per patient.

The bacteria that cause ventilator-associated pneumonia usually originate in the mouth and throat. Mechanically ventilated patients have a catheter called an endotracheal tube inserted through either their nose or mouth into the windpipe (trachea) to maintain an open airway, to deliver oxygen, and to suction mucus. The endotracheal tube raises the risk of ventilator-associated pneumonia up to 20 times by allowing bacteria access to the lungs.

The trial medication in the form of a paste was applied every 6 hours inside the mouth at the cheeks (or the buccal cavity). Oropharyngeal swabs were taken daily to determine the level of gram-positive and gram-negative microorganisms.

Of the 385 patients in the study cohort, 52 were diagnosed with ventilator-associated pneumonia: 23 in the placebo group (18 percent); 13 in the chlorhexidine group (10 percent); and 16 in the combination group (13 percent).

"The interventions tested cost less than $100 per patient, making them extremely cost effective," said Dr. Koeman.

However, the researchers noted that the experimental treatments made no difference in how long patients required mechanical ventilation or how long they had to stay intensive care unit. They also reported no change in intensive care unit survival rates.

In an editorial on the research in the same issue of the journal, Donald E. Craven, M.D., of Lahey Clinic Medical Center in Burlington, Massachusetts, and Robert A. Duncan, M.D., M.P.H., of Tufts University School of Medicine in Boston, called the findings an "impressive result for an inexpensive, non-toxic modality" that "warrants further attention."

At the same time, they argued that the study raised several important concerns. They wrote: "The use of 'sequential analysis' is an intriguing concept and offers the promise of more efficient study design, but the small number may have limited power and increased the possibility of an erroneous conclusion. For example, there appear to be significantly more males and patients with infections in the placebo group, which questions the effectiveness of randomization. Second, it is difficult to reconcile significant reductions in ventilator-associated pneumonia with an absence of effect on ventilator days, length stay and mortality."

They continued: "Why wasn't chlorhexidine ultimately more effective and why did some patients fail prophylaxis? Data is limited on how best to apply chlorhexidine paste and its pharmacokinetics, in vitro efficacy, impact on biofilm formation, or possible bacterial resistance, as reported for other topical agents. Furthermore, it is important to understand how the use of chlorhexidine and combined chlorhexidine and colistin will complement other recommended prevention strategies and health care improvement projects for ventilator-associated pneumonia."

To demonstrate the need for clear instructions for use, the editorial authors compared the risk of death from medical error (1 in 300) to that from airline travel (1 in 10 million). They also noted the growing interest in applying the principles of industrial safety to the prevention of health-care associated infections.

Although the authors called the response to date "notably slow," they pointed out that the Institute for Healthcare Improvement, through its "100,000 Lives Campaign," has successfully enlisted 3,000 hospitals in establishing safety programs that include a "ventilator-associated pneumonia prevention bundle." Recommendations for using the bundle include elevating the head of the bed by 30 degrees to prevent inhaling unwanted substances (aspiration), vacations from sedation to allow earlier tube removal, and prophylactic agents to reduce stress bleeding and deep vein thrombosis.

The authors indicated that the prevention of ventilator-associated pneumonia is a multi-disciplinary team effort in which nurses, respiratory therapists, physicians and administrators "play a vital role."

They concluded that, with the right cooperation, "zero tolerance" is an achievable goal for this deadly problem.

Suzy Martin | EurekAlert!
Further information:
http://www.thoracic.org

More articles from Health and Medicine:

nachricht Electrical 'switch' in brain's capillary network monitors activity and controls blood flow
27.03.2017 | Larner College of Medicine at the University of Vermont

nachricht Laser activated gold pyramids could deliver drugs, DNA into cells without harm
24.03.2017 | Harvard John A. Paulson School of Engineering and Applied Sciences

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Giant Magnetic Fields in the Universe

Astronomers from Bonn and Tautenburg in Thuringia (Germany) used the 100-m radio telescope at Effelsberg to observe several galaxy clusters. At the edges of these large accumulations of dark matter, stellar systems (galaxies), hot gas, and charged particles, they found magnetic fields that are exceptionally ordered over distances of many million light years. This makes them the most extended magnetic fields in the universe known so far.

The results will be published on March 22 in the journal „Astronomy & Astrophysics“.

Galaxy clusters are the largest gravitationally bound structures in the universe. With a typical extent of about 10 million light years, i.e. 100 times the...

Im Focus: Tracing down linear ubiquitination

Researchers at the Goethe University Frankfurt, together with partners from the University of Tübingen in Germany and Queen Mary University as well as Francis Crick Institute from London (UK) have developed a novel technology to decipher the secret ubiquitin code.

Ubiquitin is a small protein that can be linked to other cellular proteins, thereby controlling and modulating their functions. The attachment occurs in many...

Im Focus: Perovskite edges can be tuned for optoelectronic performance

Layered 2D material improves efficiency for solar cells and LEDs

In the eternal search for next generation high-efficiency solar cells and LEDs, scientists at Los Alamos National Laboratory and their partners are creating...

Im Focus: Polymer-coated silicon nanosheets as alternative to graphene: A perfect team for nanoelectronics

Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are less stable. Now researchers at the Technical University of Munich (TUM) have, for the first time ever, produced a composite material combining silicon nanosheets and a polymer that is both UV-resistant and easy to process. This brings the scientists a significant step closer to industrial applications like flexible displays and photosensors.

Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are...

Im Focus: Researchers Imitate Molecular Crowding in Cells

Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to simulate these confined natural conditions in artificial vesicles for the first time. As reported in the academic journal Small, the results are offering better insight into the development of nanoreactors and artificial organelles.

Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

International Land Use Symposium ILUS 2017: Call for Abstracts and Registration open

20.03.2017 | Event News

CONNECT 2017: International congress on connective tissue

14.03.2017 | Event News

ICTM Conference: Turbine Construction between Big Data and Additive Manufacturing

07.03.2017 | Event News

 
Latest News

Northern oceans pumped CO2 into the atmosphere

27.03.2017 | Earth Sciences

Fingerprint' technique spots frog populations at risk from pollution

27.03.2017 | Life Sciences

Big data approach to predict protein structure

27.03.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>