October 25, 2023
Inhaled Amikacin to Prevent Ventilator-Associated Pneumonia
What was the research question?
Population: Critically ill adults undergoing invasive mechanical ventilation for at least 72 hours.
Intervention: Inhaled amikacin at a dose of 20 mg per kilogram of ideal body weight once daily for 3 days.
Comparison: Placebo for 3 days.
Outcome: First episode of ventilator-associated pneumonia during 28 days of follow-up.
How did they do it?
Study Design: Investigator-initiated, multicenter, double-blind, randomized, controlled, superiority trial.
Trial Groups:Amikacin Group: 417 patients
Placebo Group: 430 patients
Primary Outcome: First episode of ventilator-associated pneumonia during 28 days of follow-up.
Secondary Outcome: Infection-related ventilator-associated complications.
What were the results?
Primary Outcome: Significantly different between the two groups (P=0.004).Amikacin Group: 62 patients (15%) developed ventilator-associated pneumonia.
Placebo Group: 95 patients (22%) developed ventilator-associated pneumonia.
Secondary Outcomes:Infection-related complications were higher in the placebo group compared to the amikacin group.
Trial-related serious adverse effects were slightly higher in the amikacin group, but the difference was not significantly large.
Are there any limitations of the study?
Not all patients received all three daily nebulizations; 81% in the amikacin group and 82% in the placebo group.
The trial duration was limited to 28 days, which may not capture long-term effects or complications.
What does it mean?
The results indicate that inhaled amikacin can significantly reduce the incidence of ventilator-associated pneumonia in critically ill adults who have been on mechanical ventilation for at least 3 days.
This could potentially lead to a change in practices in critical care settings to include inhaled amikacin as a preventive measure for patients on prolonged mechanical ventilation.
However, the slight increase in adverse effects in the amikacin group suggests that clinicians should weigh the benefits against potential risks.
Further research might be needed to understand the long-term effects and to confirm these findings in larger and more diverse populations.