***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: 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 prospect ively for the occurrence of ventilator-associated pneumonia . Hospital costs were defined by using the hospital cost accounting data base . 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 vs. $ 21,620 , 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 ( 95 % confidence interval = $ 5,265–$26,214;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 Objective : To determine whether use of a single heat and moisture exchanger ( HME ) for ≤120 hrs affects efficiency , resistance , level of bacterial colonization , frequency rate of nosocomial pneumonia , and cost compared with changing the HME every 24 hrs . Design : Prospect i ve , controlled , r and omized , unblinded study . Setting : Surgical intensive care unit at a university teaching hospital . Patients : A total of 220 consecutive patients requiring mechanical ventilation for > 48 hrs . Interventions : Patients were r and omized to one of three groups : a ) hygroscopic HME ( Aqua+ ) changed every 24 hrs ( HHME‐24 ) ; b ) hydrophobic HME ( Duration HME ) changed every 120 hrs ( HME‐120 ) ; and c ) hygroscopic HME ( Aqua+ ) changed every 120 hrs ( HHME‐120 ) . Devices in all groups could be changed at the discretion of the staff when signs of occlusion or increased resistance were identified . Measurements and Main Results : Daily measurements of inspired gas temperature , inspired relative humidity , and device resistance were made . Additionally , daily cultures of the patient side of the device were accomplished . The frequency rate of nosocomial pneumonia was made by using clinical criteria . Ventilatory support variables , airway care , device costs , and clinical indicators of humidification efficiency ( sputum volume , sputum efficiency ) were also recorded . Prolonged use of both hygroscopic and hydrophobic devices did not diminish efficiency or increase resistance . There was no difference in the number of colony‐forming units from device cultures over the 5‐day period and no difference between colony‐forming units in devices changed every 24 hrs compared with devices changed after 120 hrs . The average duration of use was 23 ± 4 hrs in the HHME‐24 group , 73 ± 13 hrs in the HME‐120 group , and 74 ± 9 hrs in the HHME‐120 group . Mean absolute humidity was greater for the hygroscopic devices ( 30.4 ± 1.1 mg of H2O/L ) compared with the hydrophobic devices ( 27.8 ± 1.3 mg of H2O/L ) . The frequency rate of nosocomial pneumonia was 8 % ( 8:100 ) in the HHME‐24 group , 8.3 % ( 5:60 ) in the HME‐120 group , and 6.6 % ( 4:60 ) in the HHME‐120 group . Pneumonia rates per 1000 ventilatory support days were 20:1000 in the HHME‐24 group , 20.8:1000 in the HME‐120 group , and 16.6:1000 in the HHME‐120 group . Costs per day were $ 3.24 for the HHME‐24 group , $ 2.98 for the HME‐120 group , and $ 1.65 for the HHME‐120 group . Conclusions : Changing the hydrophobic or hygroscopic HME after 3 days does not diminish efficiency , increase resistance , or alter bacterial colonization . The frequency rate of nosocomial pneumonia was also unchanged . Use of HMEs for > 24 hrs , up to 72 hrs , is safe and cost effective Objective : To document the effect of gingival and dental plaque antiseptic decontamination on the rate of  nosocomial bacteremias and respiratory infections acquired in the intensive care unit ( ICU ) . Design : Prospect i ve , multicenter , double-blind , placebo-controlled efficacy study . Setting : Six ICUs : three in university hospitals and three in general hospitals . Patients : A total of 228 nonedentulous patients requiring endotracheal intubation and mechanical ventilation , with an anticipated length of stay ≥5 days . Interventions : Antiseptic decontamination of gingival and dental plaque with a 0.2 % chlorhexidine gel or a placebo gel , three times a day , during the entire ICU stay . Measurements and Main Results : Demographic and clinical characteristics , organ function data ( Logistic Organ Dysfunction score ) , severity of condition ( Simplified Acute Physiologic Score ) , and dental plaque status were assessed at baseline and until 28 days . Bacteriologic sampling of dental plaque and saliva was done every 5 days , and blood , tracheal aspirate , and bronchoalveolar lavage cultures were performed when appropriate . The primary efficacy end point was the incidence of bacteremia , bronchitis , and ventilator-associated pneumonia , expressed as a percentage and per 1000 ICU days . All baseline characteristics were similar between the treated and the placebo groups . The incidence of nosocomial infections was 17.5 % ( 13.2 per 1000 ICU days ) in the placebo group and 18.4 % ( 13.3 per 1000 ICU days ) in the plaque antiseptic decontamination group ( not significant ) . No difference was observed in the incidence of ventilator-associated pneumonia per ventilator or intubation days , mortality , length of stay , and care loads ( secondary end points ) . On day 10 , the number of positive dental plaque cultures was significantly lower in the treated group ( 29 % vs. 66 % ; p < .05 ) . Highly resistant Pseudomonas , Acinetobacter , and Enterobacter species identified in late-onset ventilator-associated pneumonia and previously cultured from dental plaque were not eradicated by the antiseptic decontamination . No side effect was reported . Conclusions : Gingival and dental plaque antiseptic decontamination significantly decreased the oropharyngeal colonization by aerobic pathogens in ventilated patients . However , its efficacy was insufficient to reduce the incidence of respiratory infections due to multiresistant bacteria BACKGROUND The purpose of this study was to compare the performance of heat and moisture exchanger filters with heated humidifying systems in the mechanical ventilator circuit on the incidence of ventilator-associated pneumonia ( VAP ) and bacterial colonization . METHOD Two hundred and forty-three consecutive patients who required mechanical ventilation for 48 hours or more in the adult intensive care unit were r and omized to either a heat and moisture exchanger ( HME ) or a heated humidifying breathing circuit . RESULTS The VAP rate among the group with HME was 11.4 % ; the rate among the group with heated humidifying system ( HHS ) was 15.8 % . The difference was not statistically significant . Approximately 68 % of the patients in the HME group had no pathogen isolated compared with 50 % of the patients in the HHS group . This difference was statistically significant ( P = .006 ) . However , the distribution of the pathogens among those patients who had the isolated pathogens was mostly identical in the 2 groups . CONCLUSION Even though the study did not find HME to be significantly advantageous over the HHS , in as much as VAP rate is concerned , other advantages such as reduced nurses workload , reduced financial cost , and better safety made HME a more favorable device for use in our adult intensive care unit This a r and omized clinical trial in which 20 patients were prospect ively evaluated for the incidence of ventilator-associated pneumonia ( VAP ) , of whom 12 received endotracheal suctioning by an open-suction method and 8 by a closed-suction method .  Differences in the incidence of VAP was not significantly different ( p = 0.4 ) between closed and open suctioning . Differences in Acute Physiology and Chronic Health Evaluation II , duration of entubation , and the use of steroids were all not significant . All patients in the study used H2 antagonist and a nasogastric tube . Proceeding with the study will involve a sample increase with a possible change in the results Nosocomial pneumonia is the leading cause of death among all hospital-acquired infections [ 1 ] . The estimated incidence of nosocomial pneumonia in intensive care units ranges from 10 % to 65 % ; most studies [ 2 - 6 ] show case fatality rates of more than 20 % . Ventilator-associated pneumonia specifically refers to nosocomial pneumonia that develops in a mechanically ventilated patient and that was not present at the time of airway intubation [ 7 ] . Various clinical risk factors have been associated with an increased incidence of ventilator-associated pneumonia , either because they predispose the patient to bacterial colonization of the oropharynx and stomach ( for example , the administration of antacids or histamine-2-receptor antagonists ) or because they facilitate aspiration of contaminated contents from these sites ( for example , supine positioning ) [ 1 , 2 , 8 , 9 ] . Craven and colleagues [ 10 ] first showed that the frequency of ventilator circuit changes also influences the incidence of ventilator-associated pneumonia . They found that changing circuits every 24 rather than every 48 hours was independently associated with the occurrence of nosocomial pneumonia [ 10 ] . This association has been attributed to increased manipulation of the patient , the endotracheal tube , and the ventilator circuit , which results in increased aspiration of contaminated tubing condensate or upper airway secretions [ 10 , 11 ] . More recently , several groups of investigators have found that ventilator circuits can be used safely for more than 48 hours without increasing the incidence of nosocomial pneumonia [ 12 - 16 ] . However , because of limitations in the design of these studies and the small number of patients prospect ively examined , the Centers for Disease Control and Prevention has given no clear recommendation for the maximum length of time that ventilator circuits can safely be left in place during prolonged mechanical ventilation [ 17 ] . This has result ed in the development of ambiguous guidelines about the frequency with which ventilator circuits should be changed [ 18 , 19 ] and in a call for well- design ed investigations to resolve this issue [ 20 ] . We did a r and omized , controlled trial to compare the effect and cost-efficacy of routine and no routine ventilator circuit changes in patients having prolonged mechanical ventilation . Our main goals were to determine 1 ) the incidence and outcome of ventilator-associated pneumonia in patients receiving scheduled ventilator circuit changes and 2 ) whether this incidence was increased in patients whose ventilator circuits remained unchanged . Methods Study Location and Patients The study was conducted at two university-affiliated teaching hospitals : Barnes Hospital ( 900 beds ) and Jewish Hospital ( 450 beds ) . During a 7-month period ( June 1994 to December 1994 ) , all patients receiving mechanical ventilation in the intensive care units of these hospitals ( surgical , trauma , medical , cardiothoracic , and neurosurgical units at Barnes Hospital ; surgical , medical , and cardiothoracic units at Jewish Hospital ) were potentially eligible for this investigation . Patients were entered 
    Output:
    
CONCLUSION There are a growing number of evidence -based strategies for VAP prevention , which , if applied in practice , may reduce the incidence of this serious nosocomial infection