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Clinical Investigations in Critical Care |

Prevention and Diagnosis of Ventilator-Associated Pneumonia*: A Survey on Current Practices in Southern Spanish ICUs

Rafael Sierra, MD, PhD; Encarnación Benítez, MD; Cristóbal León, MD; Jordi Rello, MD, PhD
Author and Funding Information

Affiliations: *From the Intensive Care Unit (Dr. Sierra), Puerta del Mar University Hospital. University of Cádiz, Cádiz; Epidemiology Unit (Dr. Benitez), Puerta del Mar University Hospital, Cádiz; Critical Care Department (Dr. León), Virgen de Valme University Hospital, University of Sevilla, Sevilla; and Critical Care Department (Dr. Rello), Joan XXIII University Hospital, University Rovira & Virgili, Institut Pere Virgili, Tarragona, Spain.,  A list of participants is given in the Appendix.

Correspondence to: Rafael Sierra, MD, PhD, Av Amilcar Barca, 31–202, 11009 Cádiz, Spain; e-mail: rsc@comcadiz.com



Chest. 2005;128(3):1667-1673. doi:10.1378/chest.128.3.1667
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Study objectives: To assess the implementation of selected ventilator-associated pneumonia (VAP) prevention strategies, and to learn how VAP is diagnosed in the ICUs of Southern Spain.

Design: Multicentric survey.

Setting: The ICUs of 32 hospitals of the public health-care system of Southern Spain.

Patients or participants: Directors of ICUs.

Interventions: None.

Measurements and results: Twenty-eight ICUs (87.5%) returned completed questionnaires. Ventilator circuits were changed every 72 h or longer in 75% of ICUs. Use of heat and moisture exchangers and open endotracheal suction systems were reported in 96% of ICUs. Subglottic secretion drainage was never used, and 57% of ICUs checked endotracheal tube cuff pressure at least daily. Semirecumbent position was common (93%), and 67.5% of ICUs used frequently noninvasive ventilation. Continuous enteral feeding was reported in all ICUs. Sedative infusions were usually interrupted every day in 11% of ICUs. Seventy-five percent of ICUs had specific guidelines for antibiotic therapy of VAP, but rotation of antibiotics was uncommon (11%). Twenty-nine percent of ICUs diagnosed VAP without microbiological confirmation. The most used technique for microbiologic diagnosis was qualitative culture of endotracheal aspirates (42.8%). The centers with a larger structural complexity reported using VAP therapy guidelines more frequently than the smaller centers, but they did not utilized bronchoscopic techniques for diagnosing VAP.

Conclusions: Common prevention and diagnostic procedures in clinical practice, including large teaching institutions, significantly differed from evidence-based recommendations and reports by research groups of excellence. In addition, our study suggests that clinical practice for preventing and diagnosing VAP is variable and many opportunities exist to improve the care of patients receiving mechanical ventilation.

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