VAP Prevention: whats new

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VAP Prevention whats new?

• Dr David Swann
• Consultant Part-time Senior Lecturer
• Royal Infirmary University of Edinburgh

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• Cluster Randomized Trial
• Cross-over after 6 months
• 13 ICUs in Netherlands
• 5 939 patients

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• SDD
• Tobramycin, colistin amphotericin B, PO NG
• Cefotaxime 4/7, IV
• Surveillance cultures TA, oro-pharynx, rectum
• SOD
• Tobramycin, colistin amphotericin B, PO
• Surveillance cultures TA, oro-pharynx
• Control

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patients in the intervention groups tending to
be older, more likely to be intubated, and less
likely to be surgical patients and tending to
have a higher baseline APACHE II score. These
differences were not consistent with chance, and
they account for the differences between the
crude and adjusted outcomes.
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Oral Decontamination to Prevent VAP

• Some more, weak, evidence that chlorhexidine is
  effective in reducing VAP
• No convincing new evidence that SOD or SDD
  reduces mortality
• Effect of SOD or SDD on infection may be
  short-lived

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Are topical antibiotics more effective than
antiseptics in preventing VAP?

• Patients likely to be ventilated gt48h
• Cluster RCT, with cross-over
• In setting where MDROs are endemic
• Concurrent VAP prevention
• Antibiotics polymxyin/neomycin/vancomycin/amphot
  ericin
• Antiseptic 2 chlorhexidine
• VAP, diagnosed invasively
• Microbiological follow-up for hospital stay
• Hospital mortality

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Single-centre RCT Power study ?280 patients VAP
diagnosed on CF quantitative TA VAP 31/140
control v. 11/140 experimental 22
v. 8 20 v. 7.5 / 1000 ventilator days

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Multi-centre RCT Power study ? 1 800 patients VAP
diagnosed on CF quantitative BAL VAP 56/743
control v. 37/766 experimental 7.5
v. 4.8
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Promising tracheal tube developments

• Silver-coating
• Leak-resistant cuffs /- sub-glottic drainage