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Table 1 Recommendations for airway hygiene in critically ill patients for reduction in health-care-associated pneumonia

From: Clinical review: Airway hygiene in the intensive care unit

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
  1. 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.