The value of pretest probability and modified clinical pulmonary infection score to diagnose ventilator-associated pneumonia

Lauzier, François; Ruest, Annie; Cook, Deborah J.; Dodek, Peter; Albert, Martin; Shorr, Andrew F.; Day, Andrew G.; Jiang, Xuran; Heyland, Daren K.

doi:10.1016/j.jcrc.2008.01.006

Cited by 46 publications

(26 citation statements)

References 27 publications

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“…54 Furthermore, the utility of the modified CPIS to diagnose VAP was assessed in 740 subjects enrolled in a multi-center randomized trial, and no CPIS threshold was clinically useful (receiver operating characteristic area under the curve 0.47, 95% CI 0.42-0.53). 55 The authors concluded that early tracheostomy (performed after 6 -8 d of endotracheal intubation) did not result in significant reduction in the incidence of VAP compared with late tracheostomy (performed after 13-15 d of endotracheal intubation) and was associated with an adverse event related to the tracheostomy procedure in more than one third of subjects. These data suggest that tracheostomy should not be performed earlier than after 13-15 d of intubation.…”

Section: Large Retrospective Cohort Studymentioning

confidence: 95%

Tracheostomy: Epidemiology, Indications, Timing, Technique, and OutcomesDiscussion

2014

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Section: Large Retrospective Cohort Studymentioning

confidence: 95%

Tracheostomy: Epidemiology, Indications, Timing, Technique, and OutcomesDiscussion

2014

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“…• Careful utilization of combination treatment for specific resistant pathogens (P. aeruginosa and MRSA) [24][25][26].…”

Section: Treatment Strategiesmentioning

confidence: 99%

“…Physiologic measures such as laboratory examination outcomes, health status and functionality characteristics of patient may be utilized as conclusive (clinical) measures [26][27][28][29][30].…”

Section: Clinical Outcome Measuresmentioning

confidence: 99%

“…The rate of mortality of VAP may increase from 27 to 43% if antibiotic resistant organisms are causative agent with 2-3 folds increment in hospital ICU stay [25,26]. Additional cost of VAP is calculated to be $40000 per patient/hospital admission with specific ailment, with an approximated $1.2 billion per annul cost [3,27].…”

Section: Economic Features Of Vapmentioning

confidence: 99%

“…Additional cost of VAP is calculated to be $40000 per patient/hospital admission with specific ailment, with an approximated $1.2 billion per annul cost [3,27]. In a recent study [23][24][25][26][27][28][29] the advancement of VAP was connected with an expansion of $41,294 as average treatment charges per admission ($104,983 ± $91,080 vs. $63,689 ± $75,030 with P values <0.001). To rationalize the optimal economic outcome of specific disease, various pharmacoeconomic evaluation methods are utilized including cost utilization, cost effectiveness, cost benefit and cost utility analyses.…”

Section: Economic Features Of Vapmentioning

confidence: 99%

See 2 more Smart Citations

Ventilator-Associated Pneumonia (VAP): Clinical Strategies, Treatment Challenges and Economic Concerns

Zubair¹,

Ali²,

Zafar³

et al. 2017

J Bioequiv Availab

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Association Between Daily Toothbrushing and Hospital-Acquired Pneumonia

Ehrenzeller,

Klompas

2024

JAMA Intern Med

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ImportanceHospital-acquired pneumonia (HAP) is the most common and morbid health care–associated infection, but limited data on effective prevention strategies are available.ObjectiveTo determine whether daily toothbrushing is associated with lower rates of HAP and other patient-relevant outcomes.Data SourcesA search of PubMed, Embase, Cumulative Index to Nursing and Allied Health, Cochrane Central Register of Controlled Trials, Web of Science, Scopus, and 3 trial registries was performed from inception through March 9, 2023.Study SelectionRandomized clinical trials of hospitalized adults comparing daily oral care with toothbrushing vs regimens without toothbrushing.Data Extraction and SynthesisData extraction and risk of bias assessments were performed in duplicate. Meta-analysis was performed using random-effects models.Main Outcomes and MeasuresThe primary outcome of this systematic review and meta-analysis was HAP. Secondary outcomes included hospital and intensive care unit (ICU) mortality, duration of mechanical ventilation, ICU and hospital lengths of stay, and use of antibiotics. Subgroups included patients who received invasive mechanical ventilation vs those who did not, toothbrushing twice daily vs more frequently, toothbrushing provided by dental professionals vs general nursing staff, electric vs manual toothbrushing, and studies at low vs high risk of bias.ResultsA total of 15 trials met inclusion criteria, including 10 742 patients (2033 in the ICU and 8709 in non-ICU departments; effective population size was 2786 after shrinking the population to account for 1 cluster randomized trial in non-ICU patients). Toothbrushing was associated with significantly lower risk for HAP (risk ratio [RR], 0.67 [95% CI, 0.56-0.81]) and ICU mortality (RR, 0.81 [95% CI, 0.69-0.95]). Reduction in pneumonia incidence was significant for patients receiving invasive mechanical ventilation (RR, 0.68 [95% CI, 0.57-0.82) but not for patients who were not receiving invasive mechanical ventilation (RR, 0.32 [95% CI, 0.05-2.02]). Toothbrushing for patients in the ICU was associated with fewer days of mechanical ventilation (mean difference, −1.24 [95% CI, −2.42 to −0.06] days) and a shorter ICU length of stay (mean difference, −1.78 [95% CI, −2.85 to −0.70] days). Brushing twice a day vs more frequent intervals was associated with similar effect estimates. Results were consistent in a sensitivity analysis restricted to 7 studies at low risk of bias (1367 patients). Non-ICU hospital length of stay and use of antibiotics were not associated with toothbrushing.ConclusionsThe findings of this systematic review and meta-analysis suggest that daily toothbrushing may be associated with significantly lower rates of HAP, particularly in patients receiving mechanical ventilation, lower rates of ICU mortality, shorter duration of mechanical ventilation, and shorter ICU length of stay. Policies and programs encouraging more widespread and consistent toothbrushing are warranted.

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The value of pretest probability and modified clinical pulmonary infection score to diagnose ventilator-associated pneumonia

Cited by 46 publications

References 27 publications

Tracheostomy: Epidemiology, Indications, Timing, Technique, and OutcomesDiscussion

Tracheostomy: Epidemiology, Indications, Timing, Technique, and OutcomesDiscussion

Ventilator-Associated Pneumonia (VAP): Clinical Strategies, Treatment Challenges and Economic Concerns

Association Between Daily Toothbrushing and Hospital-Acquired Pneumonia

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