Please use this identifier to cite or link to this item: http://hdl.handle.net/11054/26
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dc.contributor.authorHurley, James C.*
dc.date.accessioned2012-10-02T05:20:32Zen
dc.date.available2012-10-02T05:20:32Zen
dc.date.issued2011en
dc.identifier.govdoc00013en
dc.identifier.issn1364-8535en
dc.identifier.urihttp://hdl.handle.net/11054/26en
dc.description.abstractINTRODUCTION: Selective digestive decontamination (SDD) appears to have a more compelling evidence base than non-antimicrobial methods for the prevention of ventilator associated pneumonia (VAP). However, the striking variability in ventilator associated pneumonia-incidence proportion (VAP-IP) among the SDD studies remains unexplained and a postulated contextual effect remains untested for. METHODS: Nine reviews were used to source 45 observational (benchmark) groups and 137 component (control and intervention) groups of studies of SDD and studies of three non-antimicrobial methods of VAP prevention. The logit VAP-IP data were summarized by meta-analysis using random effects methods and the associated heterogeneity (tau2) was measured. As group level predictors of logit VAP-IP, the mode of VAP diagnosis, proportion of trauma admissions, the proportion receiving prolonged ventilation and the intervention method under study were examined in meta-regression models containing the benchmark groups together with either the control (models 1 to 3) or intervention (models 4 to 6) groups of the prevention studies. RESULTS: The VAP-IP benchmark derived here is 22.1% (95% confidence interval; 95% CI; 19.2 to 25.5; tau2 0.34) whereas the mean VAP-IP of control groups from studies of SDD and of non-antimicrobial methods, is 35.7 (29.7 to 41.8; tau2 0.63) versus 20.4 (17.2 to 24.0; tau2 0.41), respectively (P < 0.001). The disparity between the benchmark groups and the control groups of the SDD studies, which was most apparent for the highest quality studies, could not be explained in the meta-regression models after adjusting for various group level factors. The mean VAP-IP (95% CI) of intervention groups is 16.0 (12.6 to 20.3; tau2 0.59) and 17.1 (14.2 to 20.3; tau2 0.35) for SDD studies versus studies of non-antimicrobial methods, respectively. CONCLUSIONS: The VAP-IP among the intervention groups within the SDD evidence base is less variable and more similar to the benchmark than among the control groups. These paradoxical observations cannot readily be explained. The interpretation of the SDD evidence base cannot proceed without further consideration of this contextual effect.en
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dc.description.provenanceApproved for entry into archive by Gemma Siemensma (gemmas@bhs.org.au) on 2012-10-02T05:20:32Z (GMT) No. of bitstreams: 100013.pdf: 558727 bytes, checksum: c8c192b5487beec3cfe3caf0a1a255eb (MD5)en
dc.description.provenanceMade available in DSpace on 2012-10-02T05:20:32Z (GMT). No. of bitstreams: 100013.pdf: 558727 bytes, checksum: c8c192b5487beec3cfe3caf0a1a255eb (MD5) Previous issue date: 2011en
dc.publisherBioMed Centralen
dc.titleParadoxical ventilator associated pneumonia incidences among selective digestive decontamination studies versus other studies of mechanically ventilated patients: benchmarking the evidence base.en
dc.typeJournal Articleen
dc.type.specifiedArticleen
dc.bibliographicCitation.titleCritical Careen
dc.bibliographicCitation.volume15en
dc.bibliographicCitation.issue1en
dc.bibliographicCitation.stpageR7en
dc.publisher.placeLondonen
dc.subject.healththesaurusMETA ANALYSISen
dc.subject.healththesaurusBENCHMARKINGen
dc.subject.healththesaurusDECONTAMINATION METHODSen
dc.subject.healththesaurusDIGESTIVE SYSTEM - MICROBIOLOGYen
dc.subject.healththesaurusEVIDENCE-BASED MEDICINEen
dc.subject.healththesaurusVENTILATOR ASSOCIATED PNEUMONIAen
dc.subject.healththesaurusRESPIRATION, ARTIFICIALen
dc.date.issuedbrowse2011-01-01en
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