Table 1

Recommendations for airway hygiene in critically ill patients for reduction in health-care-associated pneumonia

Strategies

Recommended for clinical use

Grade

Reduction in HCAP

Reduction in mortality

Refs

Effective strategies

Chlorhexidine gluconate oral rinse

Yes

A

Yes

No

11–14

Endotracheal suctioning on 'as needed' basis (compared with routine suctioning)

Yes

A

No increased incidence of HCAP

No

45,57,58

Kinetic therapy

Yes^a

A

Inconclusive

No

105–111

Ineffective strategies

Selective digestive decontamination

No

A

Inconclusive

No

15–33

Oral topical iseganan

No

B

No

No

35

Aerosolized mucus-controlling agents

No

U

N/A

N/A

85–88

Endotracheal instillation of saline

No

C

N/A

N/A

52,53

Chest physiotherapy

No

A

Inconclusive

No

114, 117–125

Strategies of equivocal or undetermined effectiveness

Continuous subglottic suctioning

Yes^b

A

Yes

No

70–75

Bronchoscopy

Yes^c

B

N/A

N/A

114

Closed (in-line) endotracheal suctioning (compared with open suctioning)

Yes^d

A

Inconclusive

No

59–68

The grading scheme used is as follows: A, supported by at least two randomized, controlled investigations; B, supported by at least one randomized, controlled investigation; C, supported by nonrandomized, concurrent-cohort investigations, historical-cohort investigations, or case series; U, undetermined or not yet studied in clinical investigations. HCAP, healthcare-associated pneumonia; N/A, not applicable. ^aThe increased cost of kinetic beds is offset by the decreased length of stay; ^bthis strategy is recommended for patients expected to require more than 72 hours of mechanical ventilation; ^cthis strategy is recommended for patients with acute atelectasis involving more than a single lung segment in the absence of air bronchograms who remain symptomatic after 24 hours of chest physiotherapy; ^dthis strategy is recommended for patients requiring mechanical ventilation for more than four days.

Jelic et al. Critical Care 2008 12:209   doi:10.1186/cc6830