Ventilator Associated Pneumonia (Sub-Category)

Estimating the attributable mortality of ventilator-associated pneumonia from randomized prevention studies

WG Melsen
MM Rovers
M Koeman
MJ Bonten

ABSTRACT

 

OBJECTIVE:  To assess the attributable mortality of ventilator-associated pneumonia using results from randomized controlled trials on ventilator-associated pneumonia prevention.

DATA SOURCES:  A systematic search was performed in PubMed, Embase, Web of Science, and Cochrane Library from their inception until July 2010.  In addition, a reference and related article search was performed.

STUDY SELECTION:  Randomized ventilator-associated pneumonia prevention studies in which all patients were mechanically ventilated and from which ventilator-associated pneumonia and mortality rates of intervention and control group could be extracted were included.

DATA EXTRACTION/SYNTHESIS:  Fifty-three papers were identified describing 58 comparisons.  Statistical significant reductions in ventilator-associated pneumonia incidences were reported in 20 of the 58 comparisons, whereas none of these trials reported a significant reduction of mortality.  Pooled estimates of the relative risk reductions of both ventilator-associated pneumonia and mortality were calculated, and the attributable mortality was estimated as the ratio between the relative risk reductions of mortality and ventilator-associated pneumonia.  Effects of study quality, diagnostic methods used, and effectiveness of preventing ventilator-associated pneumonia on the mortality rate of ventilator-associated pneumonia were assessed in subgroup analyses.  The overall attributable mortality of ventilator-associated pneumonia was estimated as 9%.  In subgroup analyses, the attributable mortality varied between 3% and 17%.

CONCLUSION:  Based on the results of 58 randomized studies on ventilator-associated pneumonia prevention, the attributable mortality rate of ventilator-associated pneumonia was estimated to be 9% and ranged between 3% and 17% in subgroup analyses.  Together with the results of other recent studies, there is cumulative evidence that the attributable mortality resulting from ventilator-associated pneumonia is approximately 10%.

PubMed Link to Article:

Melsen WG, Rovers MM, Koeman M, Bonten MJ. Estimating the attributable mortality of ventilator-associated pneumonia from randomized prevention studies. Crit Care Med. 2011 Dec;39(12):2736-42. doi: 10.1097/CCM.0b013e3182281f33. Review. PubMed PMID: 21765351.