Table 4.
Potential means to reduce ICU-acquired infection in sedated patients
| Intervention | First author [Reference] | Year of publication/country | Study design/Number of patients | Main results* |
|---|---|---|---|---|
| Daily interruption of sedation | Kress [127] | 2000/USA | Randomized controlled/128 | Shorter duration of MV (median 4.9 vs 7.3 d, P = 0.004) |
| Daily interruption of sedation, and ventilator weaning protocol | Girard [128] | 2008/USA | Randomized controlled/336 | Higher number of MV-free days (14.7 vs 11.6 days; P = 0.02) Shorter mean duration of ICU stay (9.1 vs 12.9 days; P = 0.01) Reduced ICU mortality (HR 0.68, 95% CI 0.5 to 0.92; P = 0.01) |
| Daily interruption of sedation, and early physical therapy | Schweickert [129] | 2009/USA | Randomized controlled/104 | Higher number of MV-free days (23 vs 21 days, P = 0.05) Higher rate of hospital discharge (59% vs 35%, P = 0.02) |
| Expanded ventilator bundle, including daily interruption of sedation | Papadimos [130] | 2008/USA | Before-after cohort/2968 | Reduced incidence rate of VAP (7.3 vs 19.3/1000 MV-days, P = 0.028) |
| Blamoun [131] | 2009/USA | Before-after cohort/NR | Reduced incidence rate of VAP (0 vs 12/1000 MV-days, P = 0.0006) |
|
| Resar [132] | 2005/USA and Canada | Before-after cohort/NR | Reduced incidence rate of VAP (2.7 vs 6.6/1000 MV-days) |
|
| Berriel-Cass [133] | 2006/USA | Before-after cohort/NR | Reduced incidence rate of VAP (3.3 vs 8.2/1000 MV-days) |
|
| Youngquist [134] | 2007/USA | Before-after cohort/NR | Reduced incidence rate of VAP (2.7 vs 6; and 0 vs 2.6/1000 MV-days) |
|
| Unahalekhaka [135] | 2007/Thailand | Before-after cohort/NR | Reduced incidence rate of VAP (8.3 vs 13.3/1000 MV-days) |
|
| Nurse-implemented sedation protocol | Brook [137] | 1999/USA | Randomized controlled/321 | Shorter duration of MV (55.9 vs 117.0 hours, P = 0.008) Shorter length of ICU stay (5.7 ± 5.9 vs. 7.5 ± 6.5 days; P = 0.013) |
| Arias-Rivera [138] | 2008/Spain | Before-after cohort/356 | Increased rate of successful extubation (P = 0.002) | |
| Quenot [142] | 2007/France | Before-after cohort/423 | Reduced incidence of VAP (6 vs 15%, P = 0.005) Shorter duration of MV (4.2 vs 8 days, P = 0.001) |
*intervention group compared with control group, respectively.
CI: confidence interval; HR: hazard ratio; ICU: intensive care unit; MV: mechanical ventilation; NR: not reported; VAP: ventilator-associated pneumonia;