Terminal Withdrawal of Mechanical Ventilation at a Long-Term Acute Care Hospital

Terminal Withdrawal of Mechanical Ventilation at a Long-Term Acute Care Hospital: Comparison with a medical ICU. Chest, vol. 136(2), Aug 2009, p.465-470.

White, A.C., et al.

http://www.chestjournal.org/content/136/2/465.full.pdf+html

Long-term acute care hospitals provide care for patients who require prolonged mechanical ventilation (MV) for respiratory failure. A multicenter study found weaning to be unsuccessful in 20% of patients receiving prolonged MV despite a multidisciplinary approach to care. The decision to terminally withdraw MV from critically ill patients in whom MV is no longer considered beneficial is common in ICUs in the United States and in Europe. Updated practice guidelines are available to inform practitioners in the terminal withdrawal of MV in the ICU.

A Randomized Trial of Dental Brushing for Prevening Ventilator-Associated Pneumonia

A Randomized Trial of Dental Brushing for Preventing Ventilator-Associated Pneumonia. Chest, vol. 136(2), Aug. 2009, p. 433-499.

Pobo, A., et al.

http://www.chestjournal.org/content/136/2/433.full.pdf+html

Poor oral hygiene is associated with respiratory pathogen colonization and secondary
lung infection. The impact of adding electric toothbrushing to oral care in order to reduce
ventilator-associated pneumonia (VAP) incidence is unknown. The study design was a prospective, simple-blind, randomized trial of adult patients intubated for > 48 h. Controlling for exposure to antibiotic treatment, patients were randomized to oral care every 8 h with 0.12% chlorhexidine digluconate (standard group) or standard oral care plus electric toothbrushing (toothbrush group). VAP was documented by quantitative respiratory cultures. Mechanical ventilation duration, hospital ICU length of stay, antibiotic use, and hospital ICU mortality were secondary end points.