Are specialized endotracheal tubes and heat-and-moisture exchangers cost-effective in preventing ventilator associated pneumonia?
Ventilator-associated pneumonia (VAP) is a common and serious complication of mechanical ventilation via an artificial airway. As with all nosocomial infections, VAP increases costs, morbidity, and mortality in the intensive care unit (ICU). VAP prevention is a multifaceted priority of the intensive care team, and can include the use of specialized artificial airways and heat-and-moisture exchangers (HME). Substantial evidence supports the use of endotracheal tubes (ETTs) that allow subglottic suctioning; silver-coated and antiseptic-impregnated ETTs; ETTs with thin-walled polyurethane cuffs; and HMEs, but these devices also can have adverse effects. Controversy still exists regarding the evidence, cost-effectiveness, and disadvantages and risks of these devices.
Gentile
Michael A
MA
Division of Pulmonary and Critical Care Medicine, Box 3911, Duke University Medical Center, Durham NC 27710, USA. michael.gentile@duke.edu
Siobal
Mark S
MS
D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D003362:Cost-Benefit Analysis; D004867:Equipment Design / Q000191:economics; D006801:Humans; D017053:Infection Control / Q000191:economics* / Q000295:instrumentation; D007442:Intubation, Intratracheal / Q000191:economics / Q000295:instrumentation*; D009330:Nebulizers and Vaporizers; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D012121:Respiration, Artificial / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D013396:Suction
D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local