Table 4 Potential means to reduce ICU-acquired infection in sedated patients

Daily interruption of sedation

Kress [127]

2000/USA

Randomized controlled/128

Shorter duration of MV

(median 4.9 vs 7.3 d, P = 0.004)

Daily interruption of sedation, and ventilator weaning protocol

Girard [128]

2008/USA

Randomized controlled/336

Higher number of MV-free days (14.7 vs 11.6 days; P = 0.02)

Shorter mean duration of ICU stay (9.1 vs 12.9 days; P = 0.01)

Reduced ICU mortality

(HR 0.68, 95% CI 0.5 to 0.92; P = 0.01)

Daily interruption of sedation, and early physical therapy

Schweickert [129]

2009/USA

Randomized controlled/104

Higher number of MV-free days

(23 vs 21 days, P = 0.05)

Higher rate of hospital discharge (59% vs 35%, P = 0.02)

Expanded ventilator bundle, including daily interruption of sedation

Papadimos [130]

2008/USA

Before-after cohort/2968

Reduced incidence rate of VAP

(7.3 vs 19.3/1000 MV-days, P = 0.028)

Blamoun [131]

2009/USA

Before-after cohort/NR

Reduced incidence rate of VAP

(0 vs 12/1000 MV-days, P = 0.0006)

Resar [132]

2005/USA and Canada

Before-after cohort/NR

Reduced incidence rate of VAP

(2.7 vs 6.6/1000 MV-days)

Berriel-Cass [133]

2006/USA

Before-after cohort/NR

Reduced incidence rate of VAP

(3.3 vs 8.2/1000 MV-days)

Youngquist [134]

2007/USA

Before-after cohort/NR

Reduced incidence rate of VAP

(2.7 vs 6; and 0 vs 2.6/1000 MV-days)

Unahalekhaka [135]

2007/Thailand

Before-after cohort/NR

Reduced incidence rate of VAP

(8.3 vs 13.3/1000 MV-days)

Nurse-implemented sedation protocol

Brook [137]

1999/USA

Randomized controlled/321

Shorter duration of MV

(55.9 vs 117.0 hours, P = 0.008)

Shorter length of ICU stay

(5.7 ± 5.9 vs. 7.5 ± 6.5 days; P = 0.013)

Arias-Rivera [138]

2008/Spain

Before-after cohort/356

Increased rate of successful extubation (P = 0.002)

Quenot [142]

2007/France

Before-after cohort/423

Reduced incidence of VAP

(6 vs 15%, P = 0.005)

Shorter duration of MV

(4.2 vs 8 days, P = 0.001)