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Ventilator-associated pneumonia

Leicester Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK

To the Editor:

The recent task force report is a welcome review of the situation regarding ventilator associated pneumonia (VAP) 1. In the prevention of VAP section a number of nonpharmacological measures, including posture were discussed. However there was no mention of rotational therapy 2–9. Admittedly, these publications are variously limited by: selected patient diagnoses, extensive exclusion criteria, various definitions of outcomes (including VAP), lack of controls and small numbers.

There is no trial that has produced statistically and clinically significant results that can be generalized to the majority of patients. How successful this treatment is in a wide variety of patients and how it compares with other treatment strategies, alone or in combination, needs to be studied. This subject deserves further research and should be included in the "What should be investigated" section.

References

1. Torres A, Cartlett J. on behalf of ERS/ESICM/ESCMID/ESA. Ventilator-associated pneumonia. Eur Respir J 2001;17:1034–1045.[Free Full Text]
2. Fink MP, Helsmoortal CM, Stein KL. Incidence of pulmonary complications in severely injured trauma patients managed on a conventional hospital bed or the kinetic treatment table. Nursing Research Seminar on Continuous Oscillation Therapy and Controlled Air Suspension TherapySan Antonio, TX, 1987.
3. Gentialelo L, Thompson DA, Tonese AS, et al. Effect of a rotating bed on the incidence of pneumonia and atelectasis in critically ill patients. Nursing Research Seminar on Continuous Oscillation Therapy and Controlled Air Suspension TherapySan Antonio, TX, 1987.
4. Gentialelo L, Thompson DA, Tonese AS, Hernandez D, Allen SJ, Kapadia AS. Effect of a rotating bed on the incidence of pneumonia and atelectasis in critically ill patients. Crit Care Med 1988;16:783–786.[ISI][Medline] [Order article via Infotrieve]
5. Demarest GB, Schmidt-Nowara WW, Vance LW, et al. Use of the kinetic treatment table to prevent the pulmonary complications of multiple trauma. West J Med 1989;150:35.[ISI][Medline] [Order article via Infotrieve]
6. Fink MP, Helsmoortel CM, Stein KL, Lee PC, Cohn SM. The efficacy of an oscillating bed in the prevention of lower respiratory tract infection in critically ill victims of blunt trauma. Chest 1990;97:132–137.[Abstract/Free Full Text]
7. Nelson LD, Choi SC. Kinetic therapy in critically ill trauma patients. Clin Intens Care 1992;3:248.[Medline] [Order article via Infotrieve]
8. de Boisblanc BP, Castro M, Everett B, Grender J, Walker CD, Summer WR. Effect of air-supported, continuous, postural oscillation on the risk of early ICU pneumonia in nontraumatic critical illness. Chest 1993;103:1543–1547.[Abstract/Free Full Text]
9. McKay C. Reducing nosocomial pneumonia. Regist Nurse 1999; Suppl., 3–8.

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