Oral decontamination treats the symptom, not the cause

doi:10.1136/bmj.39205.480671.BE

BMJ 2007;334:967-968 (12 May), doi:10.1136/bmj.39205.480671.BE

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Pneumonia from ventilation

Oral decontamination treats the symptom, not the cause

The first 150 words of the full text of this article appear below.

Oral antiseptics, like semirecumbent positioning and care ofthe ventilator circuit, merely address the symptom and not thecause of ventilator associated pneumonia (VAP).¹

The pivotal step in the pathogenesis of most cases is aspirationof secretions past the cuff of the tracheal tube.² Aspirationoccurs because of a design defect in almost all cuffs currentlyavailable, with leakage along folds in the cuff wall. Pepsin(a marker of gastric regurgitation and aspiration) is presentin tracheobronchial secretions in 89% of patients at some stageduring their stay in critical care and is the most importantindependent risk factor for developing VAP.³

Manufacturers are now beginning to improve the design of trachealtubes, ensuring maximal cuff performance and incorporating subglotticsecretion drainage ports and antibacterial/non-stick linings.Simply preventing the ubiquitous problem of pulmonary aspirationby cuff improvements may have a substantial impact on VAP andreduce the requirement for topical . . . [Full text of this article]

Duncan L Wyncoll, consultant intensivist¹, Peter J Young, consultant intensivist²

¹ St Thomas' Hospital, London SE1 7EH, ² Queen Elizabeth Hospital, King's Lynn PE30 4ET

duncan.wyncoll@gstt.nhs.uk

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