Effects of dental plaque antiseptic decontamination on bacterial colonization and nosocomial infections in critically ill patients

OBJECTIVES: To document in intensive care unit (ICU) patients the effect of dental plaque antiseptic decontamination on the occurrence of plaque colonization by aerobic nosocomial pathogens and nosocomial infections. DESIGN: Single-blind randomized comparative study. SETTING: A 16-bed adult intensive care unit in a university hospital. PATIENTS: Patients consecutively admitted in the ICU with a medical condition suggesting an ICU stay of 5 days and requiring mechanical ventilation. INTERVENTIONS: After randomization, the treated group received dental plaque decontamination with 0.2% chlorhexidine gel, three times a day during the ICU stay. The control group received standard oral care. SPECIFIC MEASUREMENTS: Dental status was assessed by the Caries-Absent-Occluded index; the amount of dental plaque was assessed by a semi-quantitative plaque index. Bacterial sampling of dental plaque, nasal and tracheal aspirate, blood, and urine cultures were done on days 0, 5, 10, and every week. MAIN RESULTS: Sixty patients were included; 30 in the treated group and 30 in the control one (mean age: 51 +/- 16 years; mean Simplified Acute Physiological Score II: 35 +/- 14 points). On admission, no significant differences were found between both groups for all clinical and dental data. Compared with the control group, the nosocomial infection rate and the incidence densities related to risk exposition were significantly lower in the treated group (18 vs 33% days in the ICU and 10.7 vs 32.3% days of mechanical ventilation; P < 0.05). These results were consistent with a significant preventive effect of the antiseptic decontamination (Odds Ratio: 0.27; 95% CI: 0.09; 0.80) with a 53% relative risk reduction. There was a trend to a reduction of mortality, length of stay, and duration of mechanical ventilation. CONCLUSIONS: An antiseptic decontamination of dental plaque with a 0.2% chlorhexidine gel decreases dental bacterial colonization, and may reduce the incidence of nosocomial infections in ICU patients submitted to mechanical ventilation.     

Risk factors for nosocomial bloodstream infections

A retrospective study of 205 patients was performed to identify the risk factors associated with nosocomial bloodstream infection (BSI). The study occurred during a 5-month period in four medical-surgical intensive care units (ICUs) in Athens, Greece. Risk factors were determined using single and multivariate analyses. Thirty-five patients developed nosocomial BSI (17.1%). The incidence density (defined as the number of new cases of BSI divided by the total of patient-days in the population studied; Jarvis, 1997) of BSI was 14.3 per 1000 patient-days (total number of days that patients are in the ICU during the selected time period). A multivariate model showed that only three factors were significantly and independently responsible for nosocomial BSI: the length of ICU stay (adjusted odds ratios (AOR) 1.052, 95% confidence interval (CI) 1.018-1.087, P = 0.002); the presence of trauma at admission (AOR 2.622, 95% CI 1.074-6.404, P = 0.034); and nosocomial ventilator-associated pneumonia (AOR 6.153, 95% CI 2.305-16.422, P = 0.000). These results show that the factors that had most influence on the development of nosocomial BSI were those factors associated with the treatment received by patients during ICU stay.     

Oral Care Reduces Incidence of Ventilator-Associated Pneumonia in ICU Populations

OBJECTIVE: To examine whether oral care contributes to preventing ventilator-associated pneumonia (VAP) in ICU patients. DESIGN: Nonrandomized trial with historical controls. SETTING: A medical-surgical ICU in a university hospital. PATIENTS: 1,666 mechanically ventilated patients admitted to the ICU. INTERVENTION: Oral care was provided to 1,252 patients who were admitted to the ICU during period between January 1997 and December 2002 (oral care group), while 414 patients who were admitted to the ICU during period between January 1995 and December 1996 and who did not receive oral care served as historical controls (non-oral care group). MEASUREMENTS AND RESULTS: Incidence of VAP(episodes of pneumonia per 1000 ventilator days) in the oral care group was significantly lower than that in the non-oral care group (3.9 vs 10.4). The relative risk of VAP in the oral care group compared to that in the non-oral care group was 0.37, with an attributable risk of -3.96%. Furthermore, length of stay in ICU before onset of VAP was greater in the oral care than in the non-oral care group (8.5+/-4.6 vs 6.3+/-7.5 days). However, no significant difference was observed in either duration of mechanical ventilation or length of stay between the groups (5.9+/-10.8 vs 6.0+/-8.8 days and 7.5+/-11.5 vs 7.2+/-9.5 days, respectively). Pseudomonoas aeruginosa was the most frequently detected bacteria in both groups. Number of potentially pathogenic bacteria in oral cavity was significantly reduced by single oral care procedure. CONCLUSION: Oral care decreased the incidence of VAP in ICU patients. DESCRIPTOR: Pulmonary nosocomial infection.     

The impact of ventilator-associated pneumonia on the Canadian health care system

INTRODUCTION: Ventilator-associated pneumonia (VAP) is a cause of morbidity and mortality in critically ill patients. It is associated with increased health care costs and duration of mechanical ventilation. Using published data and information from public health care providers, we sought to determine the impact of VAP on the Canadian health care system. METHODS: Ventilator-associated pneumonia incidence, attributable mortality, and intensive care unit (ICU) utilization/resource data were obtained through Canadian published and institutional data. Ontario case cost methodology was used for the cost of a critical care bed which is CAN dollars 2396 per day, excluding treatment costs. Antibiotic acquisition costs for Ontario were used. Physician reimbursement rates were obtained from the provincial ministries of health. Ventilator-associated pneumonia data, ICU resource data, and costs were combined to determine the impact of VAP. RESULTS: For the Canadian health care system; ICU utilization is 217 episodes per 100000 population and 1150 days of mechanical ventilation per 100000. The incidence of VAP is 10.6 cases per 1000 ventilator days (95% CI, 5.1-16.1). Ventilator-associated pneumonia increases ICU length of stay 4.3 days (95% CI, 1.5-7.0 days) per episode. The attributable mortality of VAP is 5.8% (95% CI, -2.4 to 14). The number of cases of VAP is estimated to be approximately 4000 cases per year (95% CI, 1900-6100). This results in 230 deaths per year with the lower and upper confidence intervals ranging from 0 to 580. Ventilator-associated pneumonia accounts for approximately 17000 ICU days per year or around 2% of all ICU days in Canada. The cost to the health care system is CAN dollars 46 million (possible range, dollars 10 million to 82 million) per year. CONCLUSION: The impact of VAP on the Canadian health care system is considerable. Eradication of this preventable nosocomial infection would save lives and conserve scarce health care resources.     

Intestinal decontamination in a polyvalent ICU

A double blind, placebo-controlled trial was performed to test the efficacy of prevention of nosocomial infections by selective digestive decontamination. Placebo or tobramycin (80 mg) and colistin (100 mg) was given four times daily via the gastric tube. Amphotericin B (500 mg/6h) was administered to all patients. As our ICU is divided into two separate subunits, intestinal decontamination or placebo was administered alternatively to patients of the two subunits during two 3-month periods, separated by a 2-month period without prevention. The decontamination (n=97) and placebo groups (n=84) were similar with respect to age, sex, severity score and diagnostic categories on admission. Intestinal decontamination alone failed to significantly reduce the number of infected patients (26% vs 34.5%,P=0.20), but was effective on ICU-acquired infections (0.33 vs 0.60,p=0.02) especially gram-negative infection rates (0.17 vs 043,p=0.01). The onset of the first ICU-acquired infection was delayed (9 vs 13 days,p<0.001) and incidence of pneumonia (2 vs 13 cases,p<0.01) including bacterial pneumonia (0 vs 8 cases,p<0.01) was significantly decreased. However, mean ICU stay and mortality were not significatly modified by intestinal decontamination.     

重症医学科医院感染监测及危险因素

目的调查分析重症医学科（ICU）医院感染率、病原菌检出分布及危险因素,为持续质量改进和提高ICU医院感染管理水平提供科学依据。 方法选取2014年1月至2015年12月苏州市吴江区第一人民医院ICU住院患者进行目标性监测,应用Logistic回归分析ICU医院感染危险因素。 结果共收集病例981例,发生医院感染100例和104例次,总体感染及总体例次感染率分别为10.19%、10.60%;与2014年比较,2015年医院感染率、例次感染率、日医院感染率和日例次感染率均有不同程度下降,特别是呼吸机相关肺炎感染发病率显著下降5.78‰;2014年和2015年医院感染均以呼吸机相关性肺炎居首位,占比均≥55%;单因素分析显示,年龄、使用呼吸机、留置导尿管、抗菌药物使用和免疫抑制剂使用等与医院感染发生相关（P<0.05）;Logistic回归分析显示,使用呼吸机、抗菌药物使用和免疫抑制剂使用是ICU医院感染的独立危险因素（OR=3.692,95%CI：3.829~7.027,P=0.012;OR=1.756,95%CI：1.191~2.590,P=0.000;OR=3.457,95%CI：2.019~5.971,P=0.000）;ICU医院感染病原菌以革兰阴性菌为主,鲍曼不动杆菌平均检出率最高,但与2014年比较,2015年该菌检出率降低了10.89%。 结论与2014年比较,2015年ICU医院感染管理水平和质量有了持续改进和提高;此外,严格掌握抗菌药物使用指征,尽量避免免疫抑制剂使用,能有效降低感染发生率,特别对老年患者更为显著。     

Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center

OBJECTIVE: To determine the attributable cost of ventilator-associated pneumonia from a hospital-based cost perspective, after adjusting for potential confounders. DESIGN: Patients admitted between January 19, 1998, and December 31, 1999, were followed prospectively for the occurrence of ventilator-associated pneumonia. Hospital costs were defined by using the hospital cost accounting database. SETTING: The medical and surgical intensive care units at a suburban, tertiary care hospital. PATIENTS: Patients requiring >24 hrs of mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We measured occurrence of ventilator-associated pneumonia, in-hospital mortality rate, total intensive care unit (ICU) and hospital lengths of stay (LOS), and total hospital cost per patient. Ventilator-associated pneumonia occurred in 127 of 819 patients (15.5%). Compared with uninfected, ventilated patients, patients with ventilator-associated pneumonia had a higher Acute Physiology and Chronic Health Evaluation II score on admission (p <.001) and were more likely to require multiple intubations (p <.001), hemodialysis (p <.001), tracheostomy (p <.001), central venous catheters (p <.001), and corticosteroids (p <.001). Patients with ventilator-associated pneumonia were more likely to be bacteremic during their ICU stay (36 [28%] vs. 22 [3%]; p <.001). Patients with ventilator-associated pneumonia had significantly higher unadjusted ICU LOS (26 vs. 4 days; p <.001), hospital LOS (38 vs. 13 days; p <.001), mortality rate (64 [50%] vs. 237 [34%]; p <.001), and hospital costs (70,568 dollars vs. 21,620 dollars, p <.001). Multiple linear regression, controlling for other factors that may affect costs, estimated the attributable cost of ventilator-associated pneumonia to be 11,897 dollars (95% confidence interval = 5,265 dollars-26,214 dollars; p <.001). CONCLUSIONS: Patients with ventilator-associated pneumonia had significantly longer ICU and hospital LOS, with higher crude hospital cost and mortality rate compared with uninfected patients. After we adjusted for underlying severity of illness, the attributable cost of ventilator-associated pneumonia was approximately 11,897 dollars.     

A continuous quality-improvement program reduces nosocomial infection rates in the ICU

Objective To assess the impact of a continuous quality-improvement program on nosocomial infection rates.Design and setting Prospective single-center study in the medical-surgical ICU of a tertiary care center.Patients We admitted 1764 patients during the 5-year study period (1995–2000); 55% were mechanically ventilated and 21% died. Mean SAPS II was 37±21 points and mean length of ICU stay was 9.7±16.1 days.Interventions Implementation of an infection control program based on international recommendations. The program was updated regularly according to infection and colonization rates and reports in the literature.Measurements and results Prospective surveillance showed the following rates per 1000 procedure days: ventilator-associated pneumonia (VAP) 8.7, urinary tract infection (UTI) 17.2, central venous catheter (CVC) colonization 6.1, and CVC-related bacteremia and2.0; arterial catheter colonization did not occur. In the 5 years following implementation of the infection control program there was a significant decline in the rate per patient days of UTI, CVC colonization, and CVC-related bacteremia but not VAP. Between the first and second 2.5-year periods the time to infection increased significantly for UTI and CVC-related colonization.Conclusions A continuous quality-improvement program based on surveillance of nosocomial infections in a nonselected medical-surgical ICU population was associated with sustained decreases in UTI and CVC-related infections.Electronic Supplementary Material Supplementary material is available in the online version of this article at .     

刷洗负压吸引法在经口气管插管患者口腔护理中的应用

目的探讨刷洗负压吸引法在经口气管插管患者口腔护理中的应用效果。方法选取ICU经口气管插管的患者82例,随机分为观察组42例和对照组40例,观察组采用刷洗负压吸引法进行口腔护理,对照组采用传统口腔护理方法。比较两组患者口腔感染发生率、呼吸机相关性肺炎（VAP）发生率、牙菌斑发生率和口腔黏膜损伤发生率。结果观察组口腔感染发生率、VAP的发生率和牙菌斑发生率分别为7．14％,2．38％,4．76％,均少于对照组的22．50％,15．00％,32．50％,差异均有统计学意义（x。分别为3．88,4．18,10．55;P〈0．05）。两组口腔黏膜损伤发生率比较差异无统计学意义（P〉0．05）。结论与传统口腔护理方法相比,刷洗负压吸引法能有效保持经口气管插管患者口腔清洁,降低口腔感染、VAP和牙菌斑的发生率。     

改良集束化策略预防呼吸机相关性肺炎的临床研究

目的研究改良的集束化策略预防呼吸机相关性肺炎的效果。方法本院收治的机械通气≥5 d患者209例,随机分为对照组（94例）和试验组（115例）。对照组应用常规方法预防呼吸机相关性肺炎;试验组在对照组基础上采用改良的集束化策略。比较2组呼吸机相关性肺炎发生率、机械通气时间及ICU住院时间及痰病原学检查结果。结果试验组呼吸机相关性肺炎发生率较对照组明显下降,机械通气时间I、CU住院时间较对照组明显缩短。结论改良集束化策略能有效预防呼吸机相关性肺炎的发生。     

神经外科重症监护病房医院感染目标性监测分析

目的分析神经外科重症监护病房（ICU）医院感染目标性监测结果,了解其医院感染特点,为干预措施的制定提供参考。方法对2013年1月-12月期间每例入住神经外科ICU≥2 d的患者及转神经外科ICU 2 d内的患者,监测其医院感染发病情况、侵入性操作使用及感染情况和多重耐药菌筛查及耐药性情况。结果共纳入1 178例患者,住院总时间4 144 d,医院感染率为4.92%,患者日感染率为13.75‰,1月、7月-12月的医院感染发病率与其他几月比较明显偏高;呼吸机使用率为9.75%,呼吸机相关性肺炎发病率为14.85‰;中心静脉导管使用率为28.40%,中心静脉导管相关性血流感染发病率为0.85‰;导尿管使用率为97.90%,导尿管相关性尿路感染发病率为0.25‰。结论神经外科ICU医院感染发病呈现明显季节性,需要医院感染控制专（兼）职人员提高警惕,及时发出风险预警,强化医院感染风险管理。     

Device-associated infection rates and extra length of stay in an intensive care unit of a university hospital in Wroclaw, Poland: International Nosocomial Infection Control Consortium's (INICC) findings

Purpose

The aim of this study was to determine device-associated health care–associated infections (DA-HAI) rates, microbiologic profile, bacterial resistance, and length of stay in one intensive care unit (ICU) of a hospital member of the International Nosocomial Infection Control Consortium (INICC) in Poland.

Materials and Methods

A prospective DA-HAI surveillance study was conducted on an adult ICU from January 2007 to May 2010. Data were collected by implementing the methodology developed by INICC and applying the definitions of DA-HAI provided by the National Healthcare Safety Network at the US Centers for Disease Control and Prevention.

Results

A total of 847 patients hospitalized for 9386 days acquired 206 DA-HAIs, an overall rate of 24.3% (95% confidence interval [CI], 21.5-27.4), and 21.9 (95% CI, 19.0-25.1) DA-HAIs per 1000 ICU-days. Central line–associated bloodstream infection rate was 4.01 (95% CI, 2.8-5.6) per 1000 catheter-days, ventilator-associated pneumonia rate was 18.2 (95% CI, 15.5-21.6) per 1000 ventilator-days, and catheter-associated urinary tract infection rate was 4.8 (95% CI, 3.5-6.5) per 1000 catheter-days. Length of stay was 6.9 days for those patients without DA-HAI, 10.0 days for those with central line–associated bloodstream infection, 15.5 days for those with ventilator-associated pneumonia, and 15.0 for those with catheter-associated urinary tract infection.

Conclusions

Most DA-HAI rates are lower in Poland than in INICC, but higher than in the National Healthcare Safety Network, expressing the feasibility of lowering infection rates and increasing patient safety.     

Incidence and etiology of pneumonia acquired during mechanical ventilation

A total of 77 consecutive patients submitted to mechanical ventilation (MV) for greater than 48 h in a respiratory ICU (RICU) were studied to investigate the incidence, etiology, and consequences of ventilator-associated pneumonia. Eighteen (23%) patients developed a bacterial pneumonia after 5.6 +/- 1.0 days (mean +/- SEM; range 2 to 17) of MV. Three additional cases were demonstrated at autopsy, raising the incidence to 27%. Overall, the mean duration of MV increased from 9.7 +/- 0.9 to 32.2 +/- 5.1 days (p less than .0001) when pneumonia developed. A longer period of hospital stay before RICU admission and the presence of chronic obstructive pulmonary disease were significant characteristics of patients with pneumonia when compared to patients without nosocomial pulmonary infection. One or more etiological agents were identified in 14 patients from the pneumonia group by means of a highly specific technique (protected brush catheter, transthoracic needle aspiration, pleural fluid, and/or blood cultures). The predominant pathogens isolated were Gram-negative bacilli (Acinetobacter sp. and Pseudomonas sp.). Half of the cases were polymicrobial. Compared to other series, our results may reflect with more accuracy the actual incidence of nosocomial pneumonia in mechanically ventilated patients, since we used highly accurate techniques along with autopsy findings which allowed us to confirm or discard the diagnosis of bacterial pneumonia.     

Prevention of ventilator-associated pneumonia,mortality and all intensive care unit acquired infections by topically applied antimicrobial or antiseptic agents: a meta-analysis of randomized controlled trials in intensive care units

Introduction  

Given the high morbidity and mortality attributable to ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients, prevention plays a key role in the management of patients undergoing mechanical ventilation. One of the candidate preventive interventions is the selective decontamination of the digestive or respiratory tract (SDRD) by topical antiseptic or antimicrobial agents. We performed a meta-analysis to investigate the effect of topical digestive or respiratory tract decontamination with antiseptics or antibiotics in the prevention of VAP, of mortality and of all ICU-acquired infections in mechanically ventilated ICU patients.     

Intérêt des soins de bouche et du brossage des dents dans la prévention des pneumonies acquises sous ventilation mécanique

Among preventive measures suggested to reduce the incidence of ventilator associated pneumonia (VAP), regular oral care is included in most of the ventilator care bundles. This nursing care usually includes oral rinses with antiseptic solutions, especially with chlorhexidine at different levels of concentration, tooth brushing, associated with repeated oral aspirations. The rational is based on VAP physiopathology: Most of microorganisms responsible for VAP come from oropharyngeal cavity and dental plaque: Oral care with chlorhexidine or other antiseptic and tooth brushing decrease bacterial colonization at this localization. If randomized trials show positive results in cardiac surgery patients, results are more conflicting in other ICU populations. Meta-analyses confirm these results with a probable but modest preventive effect, mainly in cardiac surgery patients, and they show no additional effect of tooth brushing, nor any impact on mortality, duration of mechanical ventilation or length of stay. Oral care is preeminently a basic hygiene and wellbeing care, and plays a minor role in VAP prevention.     

"集束化"治疗措施对呼吸机相关性肺炎的预防作用

目的 探讨"集束化"治疗措施在预防重症监护病房呼吸机相关性肺炎(VAP)中的作用.方法 82例经口气管插管、机械通气的患者随机分为"集束化"治疗组(集束化组)40例及传统方法治疗组(对照组)42例.比较两组患者VAP的发病率、入住ICU时间及病死率.结果 集束化组VAP发病率21.4%,平均入住ICU时间16.23d;对照组VAP发病率47.5%,平均入住ICU时间21.45d,两组差异有统计学意义;两组VAP患者较非VAP患者病死率明显增高;集束化组较对照组混合感染发生率降低,真菌感染发生率降低.结论 "集束化"治疗措施与传统治疗措施相比较能够降低VAP的发病率,减少患者入住ICU时间."集束化"治疗措施对于预防机械通气患者VAP的发生有一定作用.     

首次口腔护理时间对气管插管患者早发性呼吸机相关肺炎发生率的影响

目的探讨首次口腔护理时间对气管插管患者早发性呼吸机相关肺炎(VAP)发生率的影响。方法将入住我院ICU的120例经口气管插管患者随机均分为三组,分别在气管插管后4h内(含4h)、4~8h(含8h)、8~12h(含12h)介入首次口腔护理。比较三组患者早发性呼吸机相关肺炎发生率、机械通气时间、入住ICU时间和病死率等指标。结果三组患者的机械通气时间、入住ICU时间差异有统计学意义,早发性呼吸机相关肺炎发生率、病死率差异无统计学意义。但是,随着首次口腔护理时间的向后推迟,患者的早发性呼肺炎机相关发生率和病死率逐渐升高。结论在插管后4h内介入首次口腔护理,可降低患者的早发性呼吸机相关肺炎发生率与病死率,缩短机械通气时间、入住ICU时间,改善患者预后。     

Selective decontamination of the digestive tract with norfloxacin in the prevention of ICU-acquired infections: a prospective randomized study

The efficacy of relatively cheap regimen of selective decontamination (SDD) was evaluated in a diverse population of ICU patients. Patients requiring prolonged ICU stay (>5 days) were randomly allocated to a treatment group or control group. Control patients (n=52) received perioperative antimicrobial prophylaxis and antibiotic treatment was instituted only on sound clinical and bacteriological criteria. Treated patients (n=48) received gastro-intestinal and oro-pharyngeal decontamination with polymyxin E, norfloxacin, amphotericin B and systemic antibiotic prophylaxis with trimethoprim until decontamination was achieved. The rate of gram-positive infections was not altered by SDD. The incidence of gram-negative respiratory tract, urinary tract and line infections was significantly reduced from 44%, 27% and 15% respectively in the control group to 6%, 4% and 0% in the treatment group. Mortality from nosocomial sepsis and overall mortality were also significantly reduced from 15% and 54% to 0% and 31% respectively. The ICU stay was not reduced by SDD, nor was time on the ventilator or use of therapeutic antibiotics. The reduction in morbidity and mortality was achieved at a relatively low cost.     

Effect of oral decontamination with chlorhexidine on the incidence of nosocomial pneumonia: a meta-analysis

Introduction  

Nosocomial pneumonia is a significant cause of in-hospital morbidity and mortality. Oral care interventions have great potential to reduce the occurrence of nosocomial pneumonia. Studies using topical antiseptic agents yielded mixed results. We hypothesized that the use of chlorhexidine for oral decontamination would reduce the incidence of nosocomial pneumonia in patients requiring mechanical ventilation.     

Metoclopramide for preventing pneumonia in critically ill patients receiving enteral tube feeding: a randomized controlled trial

OBJECTIVE: To determine whether metoclopramide prevents nosocomial pneumonia in intensive care unit (ICU) patients receiving enteral feeding by a nasogastric tube. DESIGN: Prospective, randomized, controlled trial. SETTING: ICU of a university hospital. PATIENTS: A total of 305 consecutive patients requiring placement of a nasogastric tube for >24 hrs. INTERVENTIONS: Patients were randomized to receive either 10 mg of metoclopramide or placebo at 8-hr intervals through the nasogastric tube. MEASUREMENTS AND MAIN RESULTS: A total of 174 patients received placebo and 131 received metoclopramide. Baseline characteristics in the two treatment groups were comparable. Of the 305 patients, 46 developed nosocomial pneumonia, which was 24 patients (13.7%) in the placebo group and 22 (16.8%) in the metoclopramide group (p > .05). Patients in the placebo group developed pneumonia earlier than patients receiving metoclopramide (4.46+/-1.72 days [mean +/- SD[rsqb] after ICU admission compared with 5.95+/-1.78 days; p = .006). Subgroup analysis showed that metoclopramide did not reduce the frequency rate of pneumonia in patients with tracheal intubation (19 [25.3%] of 75 patients receiving metoclopramide vs. 21 [21.2%] of 99 patients receiving placebo) or those receiving mechanical ventilation (17 [25.6%] of 58 patients receiving metoclopramide vs. 20 [29.3%] of 78 patients receiving placebo). The mortality rate also did not differ in the two treatments groups (56% in the metoclopramide group vs. 53% in the placebo group; p > .05). CONCLUSIONS: Although metoclopramide delayed the development of nosocomial pneumonia, it did not decrease its frequency rate and had no effect on the mortality rate in critically ill patients receiving nasogastric enteral feeding.