title: Prevention and diagnosis of ventilator-associated pneumonia: a survey on current practices in Southern Spanish ICUs.
abstract: OBJECTIVE
  To assess the implementation of selected ventilator-associated pneumonia (VAP) prevention strategies, and to learn how VAP is diagnosed in the ICUs of Southern Spain.
  
  
  METHODS
  Multicentric survey.
  
  
  METHODS
  The ICUs of 32 hospitals of the public health-care system of Southern Spain.
  
  
  METHODS
  Directors of ICUs.
  
  
  METHODS
  None.
  
  
  RESULTS
  Twenty-eight ICUs (87.5%) returned completed questionnaires. Ventilator circuits were changed every 72 h or longer in 75% of ICUs. Use of heat and moisture exchangers and open endotracheal suction systems were reported in 96% of ICUs. Subglottic secretion drainage was never used, and 57% of ICUs checked endotracheal tube cuff pressure at least daily. Semi-recumbent position was common (93%), and 67.5% of ICUs used frequently noninvasive ventilation. Continuous enteral feeding was reported in all ICUs. Sedative infusions were usually interrupted every day in 11% of ICUs. Seventy-five percent of ICUs had specific guidelines for antibiotic therapy of VAP, but rotation of antibiotics was uncommon (11%). Twenty-nine percent of ICUs diagnosed VAP without microbiological confirmation. The most used technique for microbiologic diagnosis was qualitative culture of endotracheal aspirates (42.8%). The centers with a larger structural complexity reported using VAP therapy guidelines more frequently than the smaller centers, but they did not utilized bronchoscopic techniques for diagnosing VAP.
  
  
  CONCLUSIONS
  Common prevention and diagnostic procedures in clinical practice, including large teaching institutions, significantly differed from evidence-based recommendations and reports by research groups of excellence. In addition, our study suggests that clinical practice for preventing and diagnosing VAP is variable and many opportunities exist to improve the care of patients receiving mechanical ventilation.
authors.affiliation: Intensive Care Unit, Puerta del Mar University Hospital, University of Cádiz, Spain. rsc@comcadiz.com
authors.forename: Rafael
authors.initials: R
authors.lastname: Sierra
authors.forename: Encarnación
authors.initials: E
authors.lastname: Benítez
authors.forename: Cristóbal
authors.initials: C
authors.lastname: León
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
mesh_terms: D003422:Critical Care / Q000379:methods; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units; D011014:Pneumonia / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*; D012121:Respiration, Artificial / Q000009:adverse effects*; D013030:Spain