Prevention Of Ventilator-associated Pneumonia Research Articles

Drug Prevention and Control of Ventilator-Associated Pneumonia.

Ventilator-associated pneumonia (VAP) is one of the most prevalent and serious complications of mechanical ventilation, which is considered a common nosocomial infection in critically ill patients. There are some great options for the prevention of VAP: (i) minimize ventilator exposure; (ii) intensive oral care; (iii) aspiration of subglottic secretions; (iv) maintain optimal positioning and encourage mobility; and (v) prophylactic probiotics. Furthermore, clinical management of VAP depends on appropriate antimicrobial therapy, which needs to be selected based on individual patient factors, such as previous antibacterial therapy, history of hospitalization or mechanical ventilation, and bacterial pathogens and antibiotic resistance patterns. In fact, antibiotic resistance has exponentially increased over the last decade, and the isolation of a multidrug-resistant (MDR) pathogen has been identified as an independent predictor of inadequate initial antibiotic therapy and which is significantly associated with increased mortality. Multiple attempts were used in the treatment of VAP, such as novel antibacterial agents, inhaled antibiotics and monoclonal antibodies. In this review, we summarize the current therapeutic options for the prevention and treatment of VAP, aiming to better management of VAP in clinical practice.

Effects of different oral care scrubs on ventilator-associated pneumonia prevention for machinery ventilates patient: A protocol for systematic review, evidence mapping, and network meta-analysis.

Background:Ventilator-associated pneumonia (VAP) is defined as pneumonia develops in intensive care unit (ICU) patients who have been mechanically ventilated for at least 48 hours. Implementing effective oral car could reduce the incidence of VAP. However, previous studies on scrubs in oral care have failed to suggest which the best choice. Therefore, this protocol proposes to perform a network meta-analysis to evaluate the effectiveness of different oral care scrubs in preventing VAP.Methods:We are going to search the electronic databases: Cochrane Oral Health's Trials Register, CENTRAL, MEDLINE, EMBASE, CINAHL, and Chinese Biomedical Literature Database. Study selection and data collection will be performed independently by 2 reviewers. Cochrane Risk of Bias tool will be used to assess the risk of bias of included studies. Odds ratio (OR) and 95% confidence intervals (CIs) will be used to assess the incidence rate of VAP in critical patients. The evidence mapping (EM) method will be introduce as a tool intended to complement the conventional systematic review (SR) and is suitable for this issue, at the same time, R software will be used for representing the outcome of EM–SR. We shall assess the heterogeneity on the bias of the magnitude of heterogeneity variance parameter (I2 or Cochrane Q). We are also going to conduct subgroup analysis and sensitivity analysis if needed. The application of Stata and R software will be performed the calculations.Results:The results of this study will be submitted to a peer-reviewed journal for publication.Conclusion:This network meta-analysis will provide comprehensive evidence of different scrubs in oral care for preventing VAP.PROSPERO registration number:CRD42018117019.

A Study to Assess the Knowledge and Compliance of Critical Care Nurses Regarding Ventilator Care Bundle in Prevention of Ventilator Associated Pneumonia

Mechanical ventilation is one of the major supportive modalities in the intensive care unit but it carries a lot of risks and complications, the most common one being VAP. VAP is a problem in intensive care units worldwide and dramatically increases morbidity and mortality rates on mechanically ventilated patients. It is the most common infectious complication among patients admitted to intensive care unit[1]. Knowledge of nurses on ventilator care bundle for the prevention of VAP and adherence to them would reduce the risk of occurrence of VAP and decrease morbidity and mortality of mechanically ventilated patients in the ICU. Nursing care is growing rapidly in conjunction with technology and it is catching up with developed countries guidelines and standards of care. Nursing shortage, however, is a burden and intensive care nurses are in huge demand .The few intensive care nurses still practicing need to constantly update themselves with current knowledge and scientific evidence on many issues existent in the ICU,including VAP [2]. The four primary recommended practices includes: elevating the head of the bed to 30 degrees, sedation vacations, oral care with chlorohexidine (CHG) and subglottic suctioning endotracheal tubes. Ventilator “bundles” usually include other elements such as deep venous thrombosis (DVT) prophylaxis, peptic ulcer prophylaxis. The nurse are expected to care for these patients in a setting of intensive care unit. The nurses should have thorough knowledge of the modes of ventilation, assessment, and trouble shooting of ventilators and assessment and care of the patients requiring mechanical ventilation.[3,4]The result shows that more than half (56.7%) of the staff nurses had excellent knowledge regarding ventilator care bundle and 43.3% of them had good knowledge regarding ventilator care bundle It shows that knowledge and compliance of staff nurses regarding ventilator care bundle were found to have significant association.

Clinical Trials Focusing on Drug Control and Prevention of Ventilator-Associated Pneumonia: A Comprehensive Analysis of Trials Registered on ClinicalTrials.gov.

Objective: Clinical trials have emerged as the main force in driving the development of medicine. However, little is known about the current status of clinical trials regarding drug control and prevention of ventilator-associated pneumonia (VAP). This study aimed at providing a comprehensive landscape of these trials on the basis of ClinicalTrials.gov.Methods: A cross-sectional, descriptive study of clinical trials on drug control and prevention of VAP which have been registered on the ClinicalTrials.gov up to 25th August 2018 was conducted.Results: A total of 109 eligible trials were identified. Trials were started from 1998 to 2018, and most trials focused on adult patients. More than half trials were completed, while only 11.9% trials had results available. Sample sizes were relatively large, with a median enrollment of 146. Universities were listed as the primary sponsor for 36.7% trials, industry for 28.4% trials and hospitals for 19.3% trials. Of the 109 VAP trials, 37 trials were from in Europe, 36 in North America and 27 in Asia. Among the 97 interventional trials, 32 were phase 3 trials, 21 were phase 4 trials, and 16 were phase 2 trials. Most interventional trials were randomized trials with a parallel assignment, and 57.7% trials were blinded. Of the 12 observational trials, 9 were cohort studies, and 10 trials were prosepctive studies. Drugs about oral care, preemptive antibiotics and probiotics were most investigated for prevention. A total of 61 trials investigated drugs for the treatment of VAP, mainly focused on antibiotics. A total of 36 kinds of antibiotics were investigated for monotherapy or combination therapy. Beta-lactams were most studied, followed by aminoglycosides and polypeptides.Conclusion: Most clinical trials registered on ClinicalTrials.gov about drugs for VAP were interventional trials with the purpose for treatment. A high proportion of interventional trials were randomized, parallel assigned and masked. Our analysis highlights the need for improvement in completeness of study results on the ClinicalTrials.gov.

Knowledge of evidence‐based guidelines in ventilator‐associated pneumonia prevention

The purpose of this study was to assess the intensive care unit nurses' knowledge of evidence-based guidelines for ventilator-associated pneumonia (VAP) prevention at Guilan University of Medical Sciences (GUMS) hospitals, Guilan Province, northern Iran. This cross-sectional study included 219 nurses working in 14 intensive care units at 11 Guilan hospitals. The questionnaire consisted of three parts of demographic information, nurses' knowledge of evidence-based guidelines for the prevention of VAP, and the barrier for the implementation of these guidelines. Of the 219 nurses, 171 (response rate 78.1%) participated in this study, and their mean knowledge score was 4.6. There was no significant relation between nurses' knowledge score and their work experience (P = 0.327), education degree (P = 0.189), and their position (P = 0.168). The level of knowledge regarding VAP prevention seems inadequate in this study. Although having knowledge about the principles of evidence-based care cannot guarantee the implementation of these principles, lack of knowledge may be a potential barrier to adherence to evidence-based guidelines for the prevention of VAP.

Chest physiotherapy for the prevention of ventilator-associated pneumonia: A meta-analysis

Ventilator-associated pneumonia (VAP) remains a frequent and severe complication in mechanically ventilated patients. We undertook a meta-analysis to evaluate the efficacy of chest physiotherapy (CPT) for the prevention of VAP. A systematic literature search of PubMed and Embase databases were searched up until November 25, 2018 for published studies of mechanically ventilated patients comparing CPT with controls and reporting on the occurrence of VAP. Two authors independently selected studies and abstracted data on study quality and outcomes. We pooled data using random-effects models. A total of 6 randomized (n = 704) controlled trials were identified. CPT did not significantly reduce the incidence of VAP (risk ratio = 1.02; 95% confidence interval, 0.82-1.26; P = .87), but reduced hospital mortality (risk ratio = 0.68; 95% confidence interval, 0.48-0.95; P = .02). No significant differences were observed regarding intensive care unit mortality, length of intensive care unit stay, and duration of mechanical ventilation. CPT may not significantly reduce the incidence of VAP and alter other important clinical outcomes in adult patients receiving mechanical ventilation. However, the results should be interpreted cautiously owing to the heterogeneity and the limited trials. Further large-scale, well-designed randomized controlled trials are needed.

A Randomised Controlled Trial of Lactobacillus in the Prevention of Ventilator Associated Pneumonia

A Randomised Controlled Trial of Lactobacillus in the Prevention of Ventilator Associated Pneumonia

A Study to Assess the Knowledge and Compliance of Critical Care Nurses Regarding Ventilator Care Bundle in Prevention of Ventilator Associated Pneumonia

Mechanical ventilation is one of the major supportive modalities in the intensive care unit but it carries a lot of risks and complications, the most common one being VAP. VAP is a problem in intensive care units worldwide and dramatically increases morbidity and mortality rates on mechanically ventilated patients. It is the most common infectious complication among patients admitted to intensive care unit[1]. Knowledge of nurses on ventilator care bundle for the prevention of VAP and adherence to them would reduce the risk of occurrence of VAP and decrease morbidity and mortality of mechanically ventilated patients in the ICU. Nursing care is growing rapidly in conjunction with technology and it is catching up with developed countries guidelines and standards of care. Nursing shortage, however, is a burden and intensive care nurses are in huge demand. The few intensive care nurses still practicing need to constantly update themselves with current knowledge and scientific evidence on many issues existent in the ICU, including VAP [2]. The four primary recommended practices includes: elevating the head of the bed to 30 degrees, sedation vacations, oral care with chlorohexidine (CHG) and subglottic suctioning endotracheal tubes. Ventilator “bundles” usually include other elements such as deep venous thrombosis (DVT) prophylaxis, peptic ulcer prophylaxis. The nurse are expected to care for these patients in a setting of intensive care unit. The nurses should have thorough knowledge of the modes of ventilation, assessment, and trouble shooting of ventilators and assessment and care of the patients requiring mechanical ventilation.[3, 4]

Impact of Care Bundle on Prevention of Ventilator Associated Pneumonia in an Adult Intensive Care Unit at a Rural Tertiary Teaching Hospital

Impact of Care Bundle on Prevention of Ventilator Associated Pneumonia in an Adult Intensive Care Unit at a Rural Tertiary Teaching Hospital

Financial burden of ventilator associated pneumonia among patients in intensive care unit: Kosovo case study

Background and objective: Ventilator-associated pneumonia (VAP) is a predominant type of healthcareassociated infection (HAI) in intensive care units (ICU), associated with increased length of stay(LOS), mortality rates, and costs. We aimed to assess the financial burden of VAP in terms of direct medical costs incurred by the patients treated in ICU. Methods: A local surveillance dataset was used to perform the assessment of direct medical costs incurred by the patients while being treated for VAP in the ICU at University Clinical Centre of Kosovo (UCCK). Results: Overall, incidence rate of HAIs in the ICU at UCCK was 62.1% with VAP dominating the infection account (73.2%). The LOS in ICU ranged from 2–44 days with a median time of six days, while the distribution between VAP affected and unaffected patients ranged between 13.5 and 5.4 days, respectively. The mean cost to patients with VAP is estimated as €647±487, which is significantly higher than in patients without VAP (€227±174). Conclusion: An immediate action is required to introduce better VAP prevention and control measures in the ICU. Evidence-based practices confirm that compliance to hand-hygiene practices, ICU staff education, introduction of regular surveillance, and adequate antibiotic therapy can significantly decrease VAP incidence, save lives, decrease LOS, and reduce costs.

Training Healthcare Staff on Ventilator-Associated Pneumonia (VAP) Prevention Bundle and Its Effects on VAP Bundle on VAP

Training Healthcare Staff on Ventilator-Associated Pneumonia (VAP) Prevention Bundle and Its Effects on VAP Bundle on VAP

Evidence based guidelines for prevention of Ventilator-associated Pneumonia among Intensive Care Unit Staff Nurses

Ventilator associated pneumonia is a common hospital acquired pneumonia in ventilated patients. VAP occurs in 28% of patients who receive mechanical ventilation, where its rate of occurrence varies with the duration of mechanical ventilation. The aim of the study was to assess impact of educational intervention on knowledge and practice of intensive care staff nurses regarding evidence based guidelines for prevention of ventilatorassociated pneumonia (VAP) among patients admitted in intensive care units of New Civil Hospital, Surat. Evaluative (quantitative) research approach and pre experimental with one group pretest post test research design was adopted for this study. A sample of 30 staff nurses working in intensive care unit of New Civil Hospital, Surat were selected by non-probability purposive sampling technique. Knowledge level was assessed by selfstructured knowledge questionnaire and practice level by observational checklist. The data was analyzed by using descriptive and inferential statistics. The results revealed that maximum subjects 46.66% were between age group 20–30 years, majority 90% were female, about 80% had done GNM, 53% were having between 5–10 years of working experience. The mean posttest knowledge score was 20.67 higher than the mean pretest knowledge score 15 and mean posttest practice score was 11.8 higher than the mean pretest practice score 6.4. The karl pearson's correlation value computed between knowledge and practice scores of staff nurses r was 0.9, this indicates the existence of moderately positive correlation between knowledge and practice score. The calculated chi-square value for knowledge and practice scores with selected socio demographic variables revealed that there was no statistical association. Furthermore the study revealed that educational intervention program on evidence based guidelines for prevention of ventilator associated pneumonia was effective in improving knowledge and positive practice regarding VAP.

Knowledge Levels of Critical Care Nurses on Evidence-Based Practices for the Prevention of Ventilator-Associated Pneumonia

Knowledge Levels of Critical Care Nurses on Evidence-Based Practices for the Prevention of Ventilator-Associated Pneumonia

Exploring Risk Factors with Ventilator Associated Pneumonia among Infants in Intensive Care Units

AbstractBackground: Ventilator Associated Pneumonia (VAP) is defined as pneumonia occurring more than 48 hours after child is intubated and ventilated mechanically; VAP is the second most common hospital-acquired infection in pediatric Intensive Care Units, which linked to increased morbidity, mortality, lengths of stay in the hospital and intensive care unit with high costs.Aim of Study: The current study aimed to explore the risk factors of VAP among infants in Intensive Care Units.Subjects and Methods: A descriptive exploratory design was used to achieve the current study.Setting: The current study conducted at Pediatric Intensive Care Units at Pediatric University Hospital and Specialized Pediatric Hospital which affiliated to Cairo University Hos-pitals.Sample: A convenience sample of 54 mechanically ven-tilated infants for more than 48 hours enrolled in the study.Tools: The required data was collected by using risk factors assessment sheet and standardized observational checklists which consist of three parts: General infection control measures, nasogastric tube feeding and endotracheal tube suctioning.Results: The current study results revealed that, more than half of infants were less than 6 months of age, nearly two-thirds are males, and near to three quarters of infants developed VAP. Prior antibiotic use, sedatives administration, absence of routine oral care, previous non-invasive ventilation, reintubation, length of stay on mechanical ventilation and PICUs, coma, inadequate general infection control measures, inadequate endotracheal tube suctioning technique, supine position, inadequate nasogastric tube feeding technique, presence of nasogastric tube and oral route of endotracheal tube were statistically significant risk factors associated with VAP. More than half of VAP infants died during period of hospitalization.Conclusion: Prior antibiotic use was the only independent risk factor for incidence of VAP; and sedatives administration, absence of routine oral care, previous non-invasive ventilation, reintubation, length of stay on mechanical ventilation and PICUs were the major risk factors of VAP among infants in pediatric Intensive Care Units.Recommendations: Inservice training program should be conducted for pediatric intensive care nurses about prevention of VAP among infants. Also, similar studies should be con-ducted on large sample and different settings.

Interprofessional Approach to the Sustained Reduction in Ventilator-Associated Pneumonia in a Pediatric Intensive Care Unit.

Ventilator-associated pneumonia (VAP) increases morbidity, mortality, and health care costs. To reduce the VAP rate in the pediatric/cardiac intensive care unit to fewer than 2 events per 1000 ventilator days within 2 years and to sustain a rate near 0 for the next 5 years. An evidence-based VAP prevention bundle was developed and implemented by an interprofessional team using the Six Sigma Define, Measure, Analyze, Improve, Control methodology. The mixed unit's 5-element VAP prevention bundle consisted of age-appropriate oral care, proper airway suction technique, maintenance of safe endotracheal-tube cuff pressures, aspiration precautions, and head-of-bed elevation. Knowledge and practice were reinforced through multidisciplinary education and one-on-one teaching. Practice compliance was monitored through regular, unannounced bedside audits linked to just-in-time teaching. Within 2 years, the annual VAP rate fell from 7.86 to 1.16 events per 1000 ventilator days; VAP bundle-element compliance ranged from 86% to 99%. There were no VAP events during a 10-quarter period in 2012 through 2014. Development, implementation, and revision of a VAP prevention strategy using the Define, Measure, Analyze, Improve, Control methodology was associated with marked, sustained reduction in VAP rates, notably during the unit's expansion from 16 to 24 beds, the opening of a pediatric cardiothoracic unit, and the hiring of more than 80 new nurses. After 7 years, the VAP rate continues to be low at 0.86 for 2016 and 0 through June 2017.

Oropharyngeal Bacterial Colonization after Chlorhexidine Mouthwash in Mechanically Ventilated Critically Ill Patients.

WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Oropharyngeal care with chlorhexidine to prevent ventilator-associated pneumonia is currently questioned, and exhaustive microbiologic data assessing its efficacy are lacking. The authors therefore aimed to study the effect of chlorhexidine mouthwash on oropharyngeal bacterial growth, to determine chlorhexidine susceptibility of these bacteria, and to measure chlorhexidine salivary concentration after an oropharyngeal care. This observational, prospective, single-center study enrolled 30 critically ill patients under mechanical ventilation for over 48 h. Oropharyngeal contamination was assessed by swabbing the gingivobuccal sulcus immediately before applying 0.12% chlorhexidine with soaked swabs, and subsequently at 15, 60, 120, 240, and 360 min after. Bacterial growth and identification were performed, and chlorhexidine minimal inhibitory concentration of recovered pathogens was determined. Saliva was collected in 10 patients, at every timepoint, with an additional timepoint after 30 min, to measure chlorhexidine concentration. Two hundred fifty bacterial samples were analyzed and identified 48 pathogens including Streptococci (27.1%) and Enterobacteriaceae (20.8%). Oropharyngeal contamination before chlorhexidine mouthwash ranged from 10 to 10 colony-forming units (CFU)/ml in the 30 patients (median contamination level: 2.5·10 CFU/ml), and remained between 8·10 (lowest) and 3·10 CFU/ml (highest count) after chlorhexidine exposure. These bacterial counts did not decrease overtime after chlorhexidine mouthwash (each minute increase in time resulted in a multiplication of bacterial count by a coefficient of 1.001, P = 0.83). Viridans group streptococci isolates had the lowest chlorhexidine minimal inhibitory concentration (4 [4 to 8] mg/l); Enterobacteriaceae isolates had the highest ones (32 [16 to 32] mg/l). Chlorhexidine salivary concentration rapidly decreased, reaching 7.6 [1.8 to 31] mg/l as early as 60 min after mouthwash. Chlorhexidine oropharyngeal care does not seem to reduce bacterial oropharyngeal colonization in critically ill ventilated patients. Variable chlorhexidine minimal inhibitory concentrations along with low chlorhexidine salivary concentrations after mouthwash could explain this ineffectiveness, and thus question the use of chlorhexidine for ventilator-associated pneumonia prevention.

KNOWLEDGE REGARDING PREVENTION OF VENTILATOR ASSOCIATED PNEUMONIA AMONG NURSES IN A TERTIARY HOSPITAL, RUPANDEHI, NEPAL

Introduction: Ventilator-associated pneumonia (VAP) is the most frequent and severe infection acquired in the intensive care unit, leading to prolonged mechanical ventilation and excess mortality. This study has been conducted to find out the knowledge regarding prevention of Ventilator Associated Pneumonia (VAP) among nurses.Materials and Methods: A descriptive cross-sectional study was conducted to find out the knowledge regarding prevention of VAP among nurses. Fifty one respondents working in different intensive care areas (ICU, CCU, NICU and PICU) of Universal College of Medical Sciences - Teaching Hospital were selected as the study sample by using census method. Self-administered structured questionnaire was used to collect the data and collected data were analyzed by using descriptive and inferential statistics with SPSS software version 16.Results: The findings of the study revealed that 41.2% and 86.2% of the respondents had knowledge regarding meaning and causative agent of VAP respectively. The mean percentage of risk factors of VAP and VAP bundle were 86.2 and 61.3 respectively. About 37% of the respondents had knowledge regarding oral care with chlorhexidine, 86.3% had knowledge that ventilator circuit should be changed for every new patient and 39.2% of the respondents had knowledge that closed suction system prevents VAP. The findings of the study revealed that 49.1% of the respondents had high knowledge and 7.8% had average knowledge. There was no statistically significant association between respondents' level of knowledge regarding prevention of VAP with respondents' working experience (p=O.493) and qualification (p=O.459).Conclusion: Based on the study findings, it is concluded that almost half of the respondents have high knowledge regarding prevention of VAP. Besides this, respondents have high knowledge regarding VAP (meaning, causative agent, risk factors, principles and complications) and VAP prevention by positioning, airway humidification and suctioning and low knowledge is found on component of VAP bundle, oral care to reduce VAP and ideal cuff pressure of endotracheal tube.Journal of Universal College of Medical SciencesVol. 6, No. 1, 2018, Page: 27-31

Transcriptomic depression of immunological synapse as a signature of ventilator-associated pneumonia.

Ventilator-associated pneumonia (VAP) is one of the most commonly encountered intensive care unit (ICU) acquired infections worldwide. The objective of the study was to identify the immune alteration occurring in patients suffering from VAP at the transcriptomic level and explore its potential use for clinical diagnoses of this disease. We performed a prospective observational study in five medical ICUs. Immunological gene expression profiles in the blood of VAP patients were compared with those of controls by using whole transcriptome microarrays and droplet digital polymerase chain reaction (ddPCR) in the first 24 hours following diagnosis. VAP patients showed significantly lower expression levels of HLA-DOA, HLA-DMA, HLA-DMB, ICOS, ICOSLG, IL2RA, CD1, CD3, CD28 and CD40LG. The molecules coded by these genes participate of the immunological synapse. CD1C, CD40LG and ICOS showed the highest values of area under the receiver operating characteristic curve (AUROC) with a good balance between sensibility and specificity. Patients with VAP show a transcriptomic depression of genes participating of the immunological synapse. It takes a commonplace event, namely VAP, and highlights a quite significant underlying immune suppressive state. In effect this small study will change how we regard VAP, and proposes that we regard it as an infection in an immune compromised host, and that immunity has a central role for ICU acquired infections. This may in time change clinical practice, as it has profound implications for the role of protocolised care, or bundles, in the prevention of VAP. Quantifying the expression in blood of this genes using ddPCR could be a useful approach for the diagnosis of VAP.

"The multimodal approach for ventilator-associated pneumonia prevention"-requirements for nationwide implementation.

The multimodal approach for ventilator-associated pneumonia (VAP) prevention has been shown to be a successful strategy in reducing VAP rates in many intensive care units (ICU) in some countries. The simultaneous application of several measures or "bundles" to reduce VAP rates has achieved a higher impact than the progressive implementation of the individual interventions. The ultimate objective of recommendation bundles is their integration in the culture of routine healthcare of the staff in charge of ventilated patients for accomplished rates to persist over time. The noteworthy elements of this new strategy include the selection of the individual recommendations of the bundle, education of care workers (HCW) in the culture of patient safety, audit of compliance with the recommendations, commitment of the hospital management to support implementation, nomination and empowerment of local leaders of the projects in ICUs, both physicians and nurses, and the continuous collection of VAP episodes. The implementation of this new strategy is not an easy task, as both its inherent strength and important barriers to its application have become evident, which need to be overcome for maximal reduction of VAP rates.

Subglottic secretion drainage for ventilator-associated pneumonia prevention: an underused efficient measure.

Subglottic secretion drainage (SSD) is one of the recommended strategies to prevent ventilator-associated pneumonia (VAP) with a high level of evidence, especially regarding early-onset pneumonia. All meta-analysis found that the use of SSD reduces VAP occurrence with a relative risk (RR) reduction of 45%. In some of them, SSD reduces the duration of mechanical ventilation (MV) but without beneficial effect on intensive care unit (ICU) or hospital mortality. In spite of the edited recommendations, SSD has not been widely implemented in ICUs and remains underused. Several factors could account for this: doubts on the innocuousness of using SSD, persisting reservations on the SSD effect on other outcomes than VAP, a high variability in the volume of secretions suctioned between patients and, for each individual patient, during the period of MV and the initial increased expense of the specific endotracheal tubes (ETs) allowing SSD which limits the availability of these devices.