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Correspondence |

Perioperative Epidural Analgesia and Prevention of Ventilator-Associated Pneumonia FREE TO VIEW

Gonzalo Tornero-Campello, MD
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Hospital General Universitario de Elche Elche, Spain

Correspondence to: Gonzalo Tornero-Campello, MD, Hospital General Universitario de Elche, Anesthesiology and Reanimation, Camí de la Almazara, s/n Elche 03203, Spain; e-mail: gtorcam@hotmail.com


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;136(1):322. doi:10.1378/chest.08-2829
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To the Editor:

I read with great interest the article by Bouza et al1 in CHEST (November 2008) and the accompanying editorial by Craven and Hjalmarson.2 I celebrate both for showing ways to prevent ventilator-associated pneumonia (VAP).

According to the editorial,2 interventions such as continuous aspiration of subglottic secretions, colloidal silver-coated endotracheal tubes, sedative vacation, and targeted antibiotic therapy are capable of reducing the incidence of VAP. Surprisingly, the use of perioperative epidural analgesia was not even mentioned.

The use of epidural analgesia provides better analgesia compared with parenteral opioids,3 allowing early postoperative extubation. It has recently been shown4 that it also protects against pneumonia following abdominal or thoracic surgery.

Bouza et al1 did not mention the use of perioperative epidural analgesia in their patients. Did they ever consider the use of this technique? The use of an appropriate reference group with a specific condition must be clearly specified to consider component causes of VAP.5

Bouza E, Pérez MJ, Muñoz P, et al. Continuous aspiration of subglottic secretions in the prevention of ventilator-associated pneumonia in the postoperative period of major heart surgery. Chest. 2008;134:938-946. [PubMed] [CrossRef]
 
Craven DE, Hjalmarson K. Prophylaxis of ventilator-associated pneumonia [editorial]. Chest. 2008;134:898-890. [PubMed]
 
Block BM, Liu SS, Rowlingson AJ, et al. Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA. 2003;290:2455-2463. [PubMed]
 
Pöpping DM, Elia N, Marret E, et al. Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery: a meta-analysis. Arch Surg. 2008;143:990-999. [PubMed]
 
Rothman KJ, Greenland S, Lash TL. Causation and causal inference. Modern epidemiology. 2008; Baltimore, MD Lippincott Williams and Wilkins:5-32
 

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References

Bouza E, Pérez MJ, Muñoz P, et al. Continuous aspiration of subglottic secretions in the prevention of ventilator-associated pneumonia in the postoperative period of major heart surgery. Chest. 2008;134:938-946. [PubMed] [CrossRef]
 
Craven DE, Hjalmarson K. Prophylaxis of ventilator-associated pneumonia [editorial]. Chest. 2008;134:898-890. [PubMed]
 
Block BM, Liu SS, Rowlingson AJ, et al. Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA. 2003;290:2455-2463. [PubMed]
 
Pöpping DM, Elia N, Marret E, et al. Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery: a meta-analysis. Arch Surg. 2008;143:990-999. [PubMed]
 
Rothman KJ, Greenland S, Lash TL. Causation and causal inference. Modern epidemiology. 2008; Baltimore, MD Lippincott Williams and Wilkins:5-32
 
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