Table 1—

European Task Force(ETF), Centers for Disease Control and Prevention (CDC), Canadian Critical Care Society (CCCS) and American Thoracic Society and Infectious Diseases Society of America (ATS-IDSA) recommendations regarding nonpharmacological measures for ventilator-associated pneumonia

ETFCDCCCCSATS-IDSA
[Ref.]4567
Publication yr2001200420042005
Oral intubation better than nasalNot controversialIBRecommendedII
Optimal pressure of endotracheal tube cuffNot controversialNRNRII
Subglottic secretion drainageStill controversialIIConsideredI
Early extubationNRIBNRII
Avoid re-intubationNot controversialIINRI
Noninvasive ventilationStill controversialIINRI
Tracheostomy: early better than lateNRNRInsufficient evidenceNR
Respiratory filtersNRUnresolvedNRNR
Routine change of ventilator circuitsNO: Not controversialNO: IA in HME/II in HHNONO
HME better than HHStill controversialUnresolvedRecommendedI: is the same
Tracheal suctioning system: closed better than openStill controversialUnresolvedNRNR
Routine change of closed tracheal suctioning systemStill controversialUnresolvedNONR
Sterilisation or disinfection of respiratory devicesNRIBNRNR
Barrier measuresNot controversialIANRI
Kinetic or standard bedsNRUnresolvedConsideredNR
Semirecumbent position (30–45°)Not controversialIIRecommendedI
Feeding: post-pyloric better than gastricStill controversialUnresolvedNRNR
  • HME: heat and moisture exchanger; HH: heated humidifier; IB: the evidence comes from certain clinical or epidemiological studies; II: the evidence comes from well-designed, controlled trials without randomisation; NR: the guideline did not review this issue; I: the evidence is from well-conducted, randomised controlled trials; NO: the recommendation is of no use; IA: the evidence comes from well-designed experimental, clinical or epidemiological studies.