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
 Yesa
 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
 Yesb
 A
 Yes
 No
 70–75
     Bronchoscopy
 Yesc
 B
 N/A
 N/A
 114
     Closed (in-line) endotracheal suctioning (compared with open suctioning)
 Yesd
 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