Journal of critical care
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Journal of critical care · Mar 2008
Practice GuidelineComprehensive evidence-based clinical practice guidelines for ventilator-associated pneumonia: prevention.
Ventilator-associated pneumonia (VAP) is an important cause of morbidity and mortality in ventilated critically ill patients. ⋯ There are a growing number of evidence-based strategies for VAP prevention, which, if applied in practice, may reduce the incidence of this serious nosocomial infection.
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Journal of critical care · Mar 2008
Practice GuidelineComprehensive evidence-based clinical practice guidelines for ventilator-associated pneumonia: diagnosis and treatment.
Ventilator-associated pneumonia (VAP) is an important cause of morbidity and mortality in ventilated critically ill patients. Despite a large amount of research evidence, the optimal diagnostic and treatment strategies for VAP remain controversial. ⋯ We present evidence-based recommendations for the diagnosis and treatment of VAP. Implementation of these recommendations into clinical practice may lessen the morbidity and mortality of patients who develop VAP.
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Journal of critical care · Mar 2008
Randomized Controlled Trial Multicenter StudyDeterminants of outcome in patients with a clinical suspicion of ventilator-associated pneumonia.
In the absence of a reference standard, a probabilistic approach to the diagnosis of ventilator-associated pneumonia (VAP) has been proposed; and clinician judgment augmented by microbiological tests is used to guide therapy for patients having a clinical suspicion of VAP (CSVAP). However, the correlation of both clinician judgment at the time of CSVAP and the probability of VAP with clinical outcomes is unknown. In a cohort of patients with CSVAP, we sought to determine the correlation of clinician judgment and the probability of VAP with clinical outcomes. In addition, we studied the impact of the clinical and microbiological components of CSVAP on the processes of care and outcomes. ⋯ In patients with CSVAP, clinician judgment as to the probability of VAP does not correlate with processes of care and outcomes; and its use to group patients into those with and without VAP is of limited clinical utility.
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Journal of critical care · Mar 2008
Randomized Controlled Trial Multicenter StudyThe safety of targeted antibiotic therapy for ventilator-associated pneumonia: a multicenter observational study.
The aim of this study was to determine the safety of targeted antibiotic therapy (TT) in ventilator-associated pneumonia (VAP). ⋯ Targeted therapy is associated with less antibiotic use and no evidence of harm in the management of patients with VAP.
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Journal of critical care · Mar 2008
ReviewVentilator-associated pneumonia: Improving outcomes through guideline implementation.
Ventilator-associated pneumonia (VAP) is associated with increased duration of mechanical ventilation and increased risk of death for critically ill patients. Although scientific advances have the potential to improve the outcomes of critically ill patients who are at risk of or who have VAP, the translation of research knowledge on effective strategies to prevent, diagnose, and treat VAP is not uniformly applied in practice in the intensive care unit. Knowledge about VAP may be used more effectively at the bedside by a systematic process of knowledge translation through implementation of clinical practice guidelines. Unfortunately, there remain large gaps in our understanding of guideline implementation in the intensive care unit, specifically as it applies to guidelines for the prevention, diagnosis, and treatment of VAP.