PREVENTION OF ACQUIRED PNEUMONIA DURING A RTIFICIAL-VENTILATION (EXCLUDING THE USE OF ANTIINFECTIOUS AGENTS)

Nosocomial pneumonia remains a sei ions complication which occurs in p atients who are artificially ventilated; as neither frequency nor impo rtant sequelae have altered recently inspire of the progress which has been achieved both with diagnosis and treatment. Preventative measure s ought to be developed and realistically assessed before their introd uction. Today it is indispensable to measure the impact of these measu res, whether they have been previously or recently proposed by therape utic trials. The current techniques proposed to prevent the appearance of nosocomial pneumonia are integrated in the usual conventional grou p of measures in the struggle against nosocomial infection which rests predominently on standard approaches to hospital hygiene. These may b e more specifically directed at good practical measures for the care o f the ventilated patient. Regular toilet to the digestive and respirat ory pathway, care of the ventilator material, absence of the changing of ventilation tubing during the stay. A certain number of measures ar e specifically suggested to prevent pneumonias: they have been imperfe ctly evaluated in clinical practice and remain controversial. Thus sel ective decontamination of the digestive system has not been dealt with her but also the sitting position, the utilisation of turning or osci llating beds, the continuous aspiration of oropharyngeal secretions or the use of Sucralfate as a means of prevention stress ulcers. Today, and until a complete evaluation different techniques, the prevention o f acquired pneumopathy during artificial ventilation rests above all o n extremely simple measures; these cost little and are essentially met iculous care of the upper respiratory and digestive apparatus, to trac heal aspiration and physiotherapy which assure effective drainage and secretions, the use of the semi-sitting position, a well positioned ga stric tube, in other words, basic care of the ventilated patient of a very good quality.