title: Pneumonia prevention to decrease mortality in intensive care unit: a systematic review and meta-analysis.
abstract: BACKGROUND
  To determine the strategies of prevention of hospital-acquired pneumonia that reduce mortality in intensive care unit (ICU).
  
  
  METHODS
  We followed PRISMA (Preferred Reported Items for Systemic Reviews and Meta-Analyses) guidelines. We searched MEDLINE and the Cochrane Controlled Trials Register (through 10 June 2014) as well as reference lists of articles. We included all randomized controlled trials conducted in critically ill adult patients hospitalized in ICUs and evaluating digestive prophylactic methods (selective digestive decontamination [SDD], acidification of gastric content, early enteral feeding, prevention of microinhalation); circuit prophylactic methods (closed suctioning systems, early tracheotomy, aerosolized antibiotics, humidification, lung secretion drainage, silver-coated endotracheal tubes) or oropharyngeal prophylactic methods (selective oropharyngeal decontamination, patient position, sinusitis prophylaxis, subglottic secretion drainage, tracheal cuff monitoring). One reviewer extracted data that were checked by 3 others. The primary outcome was the mortality rate in the ICU.
  
  
  RESULTS
  We identified 157 randomized trials to pool in a meta-analysis. The primary outcome was available in 145 studies (n = 37 156). The risk ratio (RR) for death was 0.95 (95% confidence interval [CI], .92-.99; P = .02) in the intervention groups. In subgroup analysis, only SDD significantly decreased mortality compared with control (n = 10 227; RR, 0.84 [95% CI, .76-.92; P < .001]). The RR for in-ICU death was 0.78 (95% CI, .69-.89; P < .001; I(2) = 33%) in trials investigating SDD with systemic antimicrobial therapy and 1.00 (.84-1.21; P = .96; I(2) = 0%) without systemic antimicrobial therapy.
  
  
  CONCLUSIONS
  Selective digestive decontamination with systemic antimicrobial therapy reduced mortality and should be considered in critically ill patients at high risk for death.
authors.affiliation: Service d'Anesthésie Réanimation Hôtel-Dieu, Nantes University Hospital.
authors.forename: Antoine
authors.initials: A
authors.lastname: Roquilly
authors.affiliation: Department of Anesthesiology and Critical Care, Tenon University Hospital, University Pierre et Marie Curie, Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Marret
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Edward
authors.initials: E
authors.lastname: Abraham
authors.affiliation: Service d'Anesthésie Réanimation Hôtel-Dieu, Nantes University Hospital UPRES EA3826, Faculty of Médecine of Nantes.
authors.forename: Karim
authors.initials: K
authors.lastname: Asehnoune
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000401:mortality* / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D055815:Young Adult
keywords: hospital-acquired pneumonia/prevention; mechanical ventilation; mortality; selective digestive decontamination