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Editorials |

Oral Decontamination to Prevent Ventilator-Associated Pneumonia: Is It a Sound Strategy?

John Dallas, MD; Marin Kollef, MD, FCCP
Author and Funding Information

Correspondence to: Marin Kollef, MD, Washington University School of Medicine, Department of Pulmonary and Critical Care, 660 S Euclid Ave, Campus Box 8052, St. Louis, MO 63110; e-mail: mkollef@dom.wustl.edu


Drs. Dallas and Kollef are affiliated with the Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine.

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;135(5):1116-1118. doi:10.1378/chest.08-2757
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Extract

The development of ventilator-associated pneumonia (VAP) requires microbial pathogens to gain access to the lower respiratory tract. The GI and upper respiratory tract are thought to represent the primary source of these pathogens in intubated patients.1 Interruption of this process by preventing colonization with pathogenic organisms represents a potential target for preventing VAP.

A variety of strategies for decontamination of the oropharynx and GI tract have been studied. The most well-studied strategy is that of selective digestive decontamination (SDD). SDD typically involves the application of an antimicrobial paste to the oropharynx, gastric decontamination with nonabsorbed oral antibiotics, and the use of parenteral antibiotics with activity against Gram-negative organisms. Several metaanalyses2,3 have concluded that SDD significantly reduces the incidence of VAP. It may even reduce mortality in certain populations such as trauma and surgical ICU patients.2,3

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