Sunday, August 17, 2008

Sunday August 17, 2008
PEEP reduces incidence of VAP in nonhypoxemic patients



Very interesting article to analyze the effect on clinical outcomes of prophylactic positive end expiratory pressure in nonhypoxemic ventilated patients. It was a multicenter randomized controlled clinical trial from one trauma and two general ICUs in two university hospitals.

Patients: 132 mechanically ventilated patients with normal chest radiograph and Pao2/Fio2 above 250

Interventions: Patients were randomly allocated to receive mechanical ventilation with
  • 5-8 cm H2O of PEEP (PEEP group, n = 66) or
  • no-PEEP (control group, n = 65)

Results:

  • Hospital mortality rate was similar
  • Ventilator-associated pneumonia was detected in 16 (25.4%) patients in the control group and 6 (9.4%) in the PEEP group
  • The number of patients who developed hypoxemia was significantly higher in the control group (34 of 63 patients, 54%) than in the PEEP group (12 of 64, 19%) and
  • the hypoxemia developed after a shorter period in the control group than in the PEEP group (38 [20-70] hrs vs. 77 [32-164] hrs).
  • Groups did not significantly differ in incidence of ARDS (14% in controls vs. 5% in the PEEP group), barotrauma (8% vs. 2%, respectively), or atelectasis (27% vs. 19%, respectively)

Conclusions: These findings indicate that application of prophylactic PEEP in nonhypoxemic ventilated patients reduces the number of hypoxemia episodes and the incidence of ventilator-associated pneumonia.


Reference: Click to get article

Positive-end expiratory pressure reduces incidence of ventilator-associated pneumonia in nonhypoxemic patients - Critical Care Medicine. 36(8):2225-2231, August 2008.