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.
