Table 1 Characteristics of included studies
Study | Population (n) | Settings | Definition of VAP | Inclusion criteria | Exclusion criteria | Method of SSS | Antibiotic use | Evaluation unit of antibiotic consumption |
|---|---|---|---|---|---|---|---|---|
Mahul, 1992 [30] | 145 | Medical-surgical ICU | Positive bronchoalveolar lavage culture required | Expected duration of MV >3Â days | Gastrointestinal bleeding, tracheostomy, risk of reintubation, intubated before ICU | Intermittent | Antibiotic use at randomization not reported | NA |
Valles, 1995 [31] | 153 | Medical-surgical ICU | Clinical features confirmed with bronchoscopically obtained cultures | Expected duration of MV >3Â days | Intubated before arriving at the emergency department or ICU; tracheostomy | Continuous | Patients receiving antibiotics at time of randomization: 64Â % and 58Â %, intervention and control group respectively | NA |
Kollef, 1999 [32] | 343 | Cardiothoracic ICU | Clinical features, positive tracheal, blood, or pleural cultures; radiographic abscess, or positive histology | Need for MV after cardiac surgery | Intubated before ICU; transfer from outside hospital | Continuous | Antibiotics were given to 99Â % and 98Â % of intervention and control patients, respectively | NA |
Bo, 2000 [33] | 68 | Surgical ICU | Clinical features or positive blood/pleural cultures | Expected duration of MV >72Â h | Intubated outside hospital; high-risk surgery or trauma; pre-existing infection | Continuous | Antibiotics were used in 29Â % of intervention group and 36Â % of control group | NA |
Smulders, 2002 [34] | 150 | Medical-surgical ICU | Clinical features or positive blood/pleural cultures | Expected duration of MV >72Â h | Patients expected to require >72Â h MV | Intermittent | 48Â % of intervention group and 51Â % of control group were receiving antibiotics | NA |
Girou, 2004 [35] | 18 | NA | Clinical features and significant quantitative culture of aspiration | Expected duration of MV >5Â days | NA | Continuous | Prior antibiotic therapy: 1 patient in suctioning group and 4 patients in control group | NA |
Liu SH, 2006 [37] | 98 | Respiratory ICU | MV >48Â h, the chest X-ray showed pulmonary new or progressive infiltration lesions, and excluding atelectasis, pulmonary edema, and pleural effusion | Age older than 60Â years, expected MV >48Â h | NA | Intermittent | NA | NA |
Liu QH, 2006 [36] | 86 | NA | Received MV for >48Â h, clinical features and culture of endotracheal aspirate; reduction of oxygen | Age older than 60Â years, expected MV >48Â h | 1) expected death within 48Â h; 2) expected weaning within 48Â h; 3) existing lung infection when MV beginning | Continuous | NA | NA |
Lorente, 2007 [38] | 280 | NA | Clinical features and significant quantitative culture via ETT aspiration | Expected MV >24Â h | Age less than 18Â years, pregnancy, infection with human immunodeficiency virus, blood leukocyte count less than 1000 cells/mm3, solid or hematological tumor, and/or immunosuppressive therapy | Continuous | 83.6Â % of ETT-PUC-SSD group and 85Â % of ETT-C group were receiving antibiotics after cardiothoracic surgery | NA |
Bouza, 2008 [39] | 704 | Cardiothoracic ICU | Received MV for >48Â h, clinical features and culture of endotracheal aspirate; reduction of oxygen | Major heart surgery | NA | Continuous | Both group respectively received antibiotics before surgery and every 8Â h thereafter for a total of three doses in the ICU | Daily defined doses |
Yang, 2008 [40] | 91 | Medical-surgical ICU | Clinical features and culture of endotracheal aspirate | MV >48Â h | Intubated before ICU | Continuous | NA | NA |
Zheng, 2008 [41] | 61 | Medical-surgical ICU | NA | MV >48Â h | NA | Continuous | NA | NA |
Lacherade, 2010 [42] | 333 | Multicenter, medical-surgical ICU | Quantitative culture of protected telescoping catheter sample or bronchoalveolar lavage fluid following clinical suspicion | Expected MV >48Â h | Intubated before ICU; tracheostomy; psychotropic drug overdose; acute drunkenness; cardiac arrest | Intermittent | Antibiotics therapy was used in 94Â % and 92Â % of intervention and control groups respectively | NA |
Seyfi, 2013 [43] | 80 | ICU of Hazrat Rasool Akram Hospital of Tehran, Iran. | NA | NA | NA | Intermittent | NA | NA |
Safdari, 2014 [23] | 76 | In four ICUs of Educational Hospital in Isfahan, Iran | NA | Intubated with a conventional endotracheal tube and connected to ventilators for more than 48Â h | Patients who were admitted to the ICUs with tracheostomy or likely to die in the next 48Â h or admitted to these units for treatment of pneumonia or with lung complications like fibrosis or cancer | Intermittent performed every 3Â h | NA | NA |
Koker, 2014 [24] | 51 | In a 14-bed ICU | NA | Requiring prolonged MV for more than 48Â h | NA | Continuous | NA | NA |
Tao, 2014 [22] | 149 | NA | Received MV for >48 h, clinical features and culture of endotracheal aspirate; reduction of oxygen | Expected MV >48 h with APACHE score 20–30 | Existing lung infection when MV beginning | Continuous or intermittent every 4 h | NA | NA |
Damas, 2015 [17] | 352 | All ICUs of a tertiary hospital | Clinical features and culture of endotracheal aspirate | Age over 18Â years, intubation with a Teleflex Isisâ„¢ endotracheal tube (TIET) allowing subglottic secretion suctioning | Patient participating in another study or having already participated in this study | NA | NA | The numberof antibiotic days |
Gopal, 2015 [21] | 240 | Cardiothoracic surgery | Europe Infection Control through Surveillance definition | Age over 70Â years and/or left ventricular ejection fraction <50Â % and cardiac surgery | NA | Intermittent every 6Â h | NA | NA |
Deem, 2016 [20] | 66 | All ICUs at Harborview Medical Center | Criteria of Center for Disease Control | Age over 18Â years with intubation and needed critical care | 1) Out-of-hospital cardiac arrest; 2) non-study designated intubation devices; 3) airway management other than orotracheal intubation; 4) Federally protected populations, pregnant women, and prisoners | Continuous | NA | NA |