Table 1.
Summary of findings from Cochrane reviews of VAP prevention interventions a
| Intervention | Ref | VAP incidence (per 1000 patients) | Mortality incidence (per 1000 patients) | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Control | Intervention | RR; (95% CI) | n/N | Control | Intervention | RR; (95% CI) | n/N | ||
| Semi-recumbent b | [20] | 316 | 139 | 0·44; 0·11–1·77 | 3/419 | 276 | 240 | 0·87; 0·59–1·27 | 2/307 |
| HME c | [21] | 167 | 155 | 0·93; 0·73–1·19 | 13/2251 | 247 | 257 | 1·03; 0·89–1·2 | 12/1951 |
| Probiotic d | [22] | 309 | 238 | 0·7; 0·52–0·95 | 8/1018 | 214 | 186 | 0·84; 0·58–1·22 | 5/703 |
| Chlorhexidine e | [23] | 243 | 180 | 0·75; 0·62–0·91 | 18/2451 | 222 | 242 | 1·09; 0·96–1·23 | 14/2014 |
| Tooth brushing f | [23] | 253 | 206 | 0·69; 0·44–1·09 | 5/889 | 269 | 237 | 0·87; 0·7–1·09 | 5/889 |
| TAP + PPAP g | [1] | 417 | 179 | 0·43; 0·35–0·53 | 17/2951 | 303 | 255 | 0·84; 0·73–0·96 | 18/5290 |
| TAP (alone) h | [1] | 324 | 162 | 0·50; 0·36–0·69 | 13/1848 | 305 | 296 | 0·97; 0·87–1·07 | 15/3274 |
| TAP + PPAP (versus PPAP) i, j | [1] | 303 | 278 | 0·82; 0·58–1·16 | 6/247 | 237 | 221 | 0·92; 0·72–1·18 | 7/1039 |
an/N is number of participants/number of studies
bSemi-recumbent position; pneumonia is microbiologically confirmed VAP at > 48 h and mortality is ICU mortality at > 48 h
cHME (heat and moisture exchanger); pneumonia measured at a median 4 days (from Analysis 1.3 on page 65 of ref [21]) and mortality measured at a median 8 days
dProbiotic; pneumonia is VAP measured at a median 37 days and mortality measured at a median 35 days
eChlorhexidine (mouth rinse or gel); pneumonia is VAP measured at a median 1 month and mortality measured at a median 1 month
fToothbrushing; pneumonia is VAP measured at a mean 1 month and mortality measured at a mean 1 month
gTAP + PPAP studies; pneumonia is respiratory tract infection at unspecified follow up and mortality is at unspecified follow up. These studies resemble those having designs as in Fig. 1b
hTAP alone; pneumonia is respiratory tract infection at unspecified follow up (note this does not include 6 studies for which the control group received PPAP) and mortality is at unspecified follow up. These studies resemble those having designs as in Fig. 1a
iTAP + PPAP versus PPAP (duplex studies); pneumonia is respiratory tract infection at unspecified follow up and mortality is at unspecified follow up. These studies resemble those having designs as in Fig. 1c
jNote that only one study [10] having a NCC design (as in Fig. 1d) is included within the systematic review of TAP[1]