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Introdução: a Pneumonia Associada à Ventilação Mecânica é a mais importante e comum infecção que acomete os pacientes em ventilação mecânica. Além disso, é considerada um grave problema de saúde hospitalar, com preocupantestaxas de morbimortalidade.Objetivo: investigar na literatura quais as principais ações de enfermagem para a prevenção da Pneumonia Associada à Ventilação Mecânica. Metodologia:trata-se de um estudo do tipo revisão integrativa da literatura. Após utilizar a estratégia PICO, definiu-se a seguinte pergunta norteadora: "Quais as principais intervenções de enfermagem para a prevenção da Pneumonia Associada à Ventilação Mecânica?". Com a leitura e aplicação dos critérios de seleção, foram utilizados nove artigos. Resultados:as principais intervenções de enfermagem descritas foram elevação da cabeceira entre 30-45 graus, manter pressão do cuff entre 20 e 30 cmH2O, higienização oral com clorexidina 0,12%, higienização das mãos, aspiração de secreções e interrupção diária da sedação. Com relação à adesão dos profissionais, a maioria das intervenções atingiram de 50% a 70% de adesão.Conclusão:as principais medidas preventivas constantes na literatura são utilizadas na prática clínica pelos enfermeiros, e estes demonstram boa adesão sobre os cuidados imprescindíveis para a prevenção da Pneumonia Associada à Ventilação Mecânica (AU).
Introduction:Ventilator-AssociatedPneumoniais the most important and common infection that affects patients on mechanical ventilation. Furthermore, it is considered a serious hospital health problem,with worrying morbidity and mortality rates.Objective:to investigate in the literature which are the main nursing actions for the prevention of Ventilator-Associated Pneumonia. Methodology:this is an integrative literature review study. After using the PICO strategy, the following guiding questionwas defined: "What are the main nursing interventions for preventingVentilator-Associated Pneumonia?". After reading and applying the selection criteria, nine articles were used. Results:the main nursing interventions described were elevation of the headboardbetween 30-45 degrees, maintaining cuff pressure between 20 and 30 cmH2O, oral hygiene with 0.12%chlorhexidine, hand hygiene, suctionof secretions and daily interruption of sedation. Regarding professional adherence, most interventions reached 50% to 70% adherence. Conclusion:the main preventive measures listed in the literature are used in clinical practice by nurses,and they demonstrate good adherence to essential care for the prevention of Ventilator-Associated Pneumonia (AU).
Introducción:la Neumonía Asociada a Ventilación Mecánica es la infección más importante y común que afecta a los pacientes que recibenventilación mecánica. Asimismo, se considera un grave problema de salud hospitalaria,con preocupantes tasas de morbimortalidad.Objetivo: investigar en la literatura cuáles son las principales acciones de enfermería para la prevención de la Neumonía Asociada a Ventilación Mecánica. Metodología:se trata de un estudio de revisión integrativade la literatura. Después de utilizar la estrategia PICO, se definió la siguiente pregunta orientadora: "¿Cuáles son las principales intervenciones de enfermería para la prevención de la Neumonía Asociada a Ventilación Mecánica?".Luegode la lectura y aplicación de los criterios de selección, se utilizaron nueve artículos. Resultados:las principales intervenciones de enfermería descritas fueron elevarla cabeceraentre 30-45 grados, mantenerla presión del manguito entre 20 y 30 cmH2O, higiene bucal conclorhexidina al 0,12%, higiene de manos, aspiración de secreciones e interrupción diaria de la sedación.En cuanto a la adherencia profesional, la mayoría de las intervenciones alcanzaron entre un 50% y un70% de adherencia. Conclusión:las principales medidas preventivas contenidas en la literatura son utilizadas en la práctica clínica por los enfermeros,y muestran una buena adherencia a los cuidados esenciales para la prevención de la Neumonía Asociada a Ventilación Mecánica (AU).
Subject(s)
Humans , Primary Nursing , Ventilation , Pneumonia, Ventilator-Associated/prevention & control , Nursing Care , Respiration, Artificial , Delivery of Health CareABSTRACT
Background: Ventilator associated pneumonia (VAP) is very common in pediatric intensive care unit (PICU) intubated patients and also responsible for major morbidity and mortality. Usually, it develops after 48 hours of mechanically ventilated patients, its incidence increases as the duration of time increases and it is a major risk factor for VAP. The present study was carried out to know the overall incidence of VAP in mechanically ventilated patients in PICU.Methods: The study was carried out in PICU of the department of pediatrics, B. R. D. Medical College, Gorakhpur from October 2020 to October 2021. Patients aged between 1 year to 15 years were included in the study.Results: There were 50 (59.5%) patients� male and 34 (40.5%) patients� female under investigation. The clinical pulmonary infection score (CPIS) values ranged from the mean value of 4.38�30 at 36th hours to 7.33�92 at 96th hours of intubation. VAP was present in 23 (27.3%) patients while 62 (73.8%) patients were having no VAP. Among VAP associated patients, 14.3% were Acinetobacter positive, 5.95% were Klebsiella positive and 3.57% were E. coli positive.Conclusions: Parameters of CPIS associated with VAP revealed that Acinetobactor was comparative more common organism and the age group of 1 to 5 years was more sensitive. VAP can be reduced by decreasing the duration of mechanical ventilation.
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Background: Healthcare is a professional area bound to the ethical foundation of “do no harm.”, But in the current scenario, a rush to promote the curative scenario has led to the total downplay of the preventive aspect of care. The aim of this study was to assess the knowledge regarding nursing care bundle for the prevention of VAP among nursing officers before and after clinical teaching and to evaluate the effectiveness of clinical teaching. Methods: This pretest-post-test study was conducted on nursing officers working in the ICU of the All-India Institute of Medical Sciences, Bhopal, Madhya Pradesh. 100 nursing officers were enrolled in the study via convenience sampling technique. The self-structured tool was validated by 10 experts with a mean CVI value of 0.94. The reliability of the self-structured knowledge questionnaire was determined by the test-retest method and found to be 0.87. The collected data was analysed for frequency, mean, standard deviation, t-test, and association. Results: Findings showed that the mean knowledge score was 18.46±3.543 before intervention. After the intervention of video-assisted clinical teaching, a post-test was conducted, and the mean post-test knowledge scores was 25.07±2.801 at the p value <0.01. Knowledge of subjects about nursing care bundle for prevention of VAP was found to have a significant association with only educational qualification. Conclusions: This study's findings concluded that educational interventions are necessary for the enhancement of knowledge and better compliance of nursing officers with guidelines regarding the bundle of care for the prevention of ventilator-associated pneumonia.
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Background: Among nosocomial hospital acquired infections Ventilator associated pneumonia (VAP) is the most frequently acquired infections, particularly in patients on ventilators. To evaluate the use of antimicrobials among ventilator associated pneumonia patients in intensive careAim: unit of a tertiary care hospital. The study is cross-sectional, observational, prospective & analytical type. 207 patients wereMaterial & method: analyzed for the period of August 2021 to Dec 2022, on a pre-designed format. A total of 207 patients who ful?lled the inclusion criteriaResult: were analyzed. 134(65.05%) were males and 72(34.95%) were females. Commonly prescribed AMA's were ceftriaxone (76.33%), metronidazole (62.32%), piperacillin-tazobactum (37.68%) and vancomycin (35.26%). From the following study, an initial data is being providedConclusion: for a positive enhancement of rational prescribing of antimicrobial drugs in patients with Ventilator Associated pneumonia in a tertiary care hospital.
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Background: Hospital acquired infections, are a leading cause of mortality and morbidity. Ventilator associated pneumonia, one of the hospital acquired illnesses. The purpose of this study was to evaluate the prevalence, risk factors, causative organism, and antibiotic usage for the treatment of ventilator-associated pneumonia. Methods: Between May 2022 and October 2022, 50 patients participated in an ambispective and observational study conducted across several ICU departments at Adichunchanagiri Hospital, BG Nagara, Karnataka. Reviewing and evaluating daily patient case sheets, laboratory results, and treatment charts of participants who were hospital inpatients provided pertinent data needed for the study. Volunteers were enrolled after taking consent from each of them, a suitably designed data collection form was used to collect all the necessary information. Microsoft Excel was used to enter the data. Version 28 of SPSS was used to analyze the data. Statistical significance was determined by using a P-value of less than 0.05. Results: The study included 50 patients and discovered a 60% prevalence of ventilator-associated pneumonia in the general community. Staphylococcus aureus accounted for 26.7% of all gram-positive bacteria, whereas Enterobacter and Klebsiella species accounted for 16.7%. Metronidazole was given in 64% of instances, with accidents being the most frequent risk factor (40%). Conclusions: Within the specified population, the incidence of ventilator-associated pneumonia is 60%, with Staphylococcus aureus identified as the most predominant bacterial pathogen. Metronidazole is the most frequently prescribed antibiotic, and accidents are the key risk factors that cause ventilator-associated pneumonia.
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Background: The lower respiratory tract infections (LRTIs), including pneumonia, are the fourth most common cause of mortality globally and the second most frequent reason for years of life lost. India is home to one-quarter of the world’s pneumonia cases. Aims and Objectives: The present study was aimed to evaluate the clinical, bacteriological and radiological profile of CAP, HAP and VAP patients from a tertiary care teaching hospital. Material & Methods: This cross-sectional, observational study was conducted at the Department of Pulmonary Medicine, Bharati Vidyapeeth (DTU) Medical College and Hospital, Pune, India. The study included 100 clinically diagnosed patients of community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP). Patients were evaluated for clinical symptoms, microbiological investigations, radiological assessment, treatment given, and final outcome. Severity indices were calculated for CAP, HAP, and VAP patients to predict the severity and rate of mortality. Results: The most common symptoms are cough, fever, and shortness of breath. The most common organisms isolated in sputum cultures of patients with pneumonia are Streptococcus, Pseudomonas, and Acinetobacter. The most common site of consolidation on chest X-ray is bilateral. Mortality rates are highest in patients with ventilator-associated pneumonia (VAP), followed by hospital-acquired pneumonia (HAP) and community-acquired pneumonia (CAP). Conclusion: The most common symptoms of pneumonia are cough, fever, crepitation, and expectoration. Mortality rates are highest in patients with VAP, followed by HAP and CAP.
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Introducción: los pacientes con COVID-19 ingresan en mayor proporción a asistencia respiratoria mecánica, aumentando: el riesgo de neumonía asociada a ventilador (NAV) las tasas de mortalidad, los días de permanencia en las unidades de terapia intensiva (UCI) y los costos sanitarios. Objetivo: determinar la Mortalidad intrahospitalaria de pacientes con COVID-19 complicados con neumonías bacterianas en asistencia respiratoria mecánica en Cuidados Intensivos de Adultos en un Hospital del Paraguay durante los años 2020 a 2021. Metodología: estudio analítico de tipo cohorte retrospectiva. Se registraron variables demográficas, comorbilidades, puntajes en scores de gravedad como el APACHE II al ingreso, la cifra más baja de oxigenación durante la internación expresado por la PaO2 / FIO2, días de ventilación, colocación en decúbito prono, traqueotomía, medidas terapéuticas farmacológicas y no farmacológicas, días de internación, así como las complicaciones y la mortalidad. Resultados: fueron incluidos 214 pacientes, 135 ingresaron a asistencia respiratoria mecánica (ARM) de los cuales 58 (42,9 %) desarrollaron NAV, con edad mediana de 52 años (40-60). Los microorganismos de NAV fueron cocos Gram negativos en 98,3 %, incluyendo Acinetobacter baumanii en 46,5 %, Klebsiella pneumoniae en 22,8 %, Pseudomona aeruginosa en 15,5 % y 5,2 % Stenotrophomona maltofilia. La mortalidad intrahospitalaria fue del 44,8 %. Los menores de 50 años tienen una sobrevida mayor que los mayores (34 días vs 22 días, con p de 0,026). Conclusión: la mortalidad intrahospitalaria fue del 44,8 %. La edad fue un factor de riesgo independiente para la mortalidad en pacientes con NAV, por lo que los profesionales de la salud deben estar atentos a la posibilidad de NAV en pacientes que requieren asistencia respiratoria mecánica, especialmente en pacientes mayores de 50 años.
Introduction: patients with COVID-19 are more likely to require mechanical ventilation, which increases the risk of ventilator-associated pneumonia (VAP), mortality rates, length of stay in intensive care units (ICUs), and healthcare costs. Objective: to determine the in-hospital mortality of patients with COVID-19 complicated by bacterial pneumonia on mechanical ventilation in Adult Intensive Care in a Hospital in Paraguay during the years 2020 to 2021. Methodology: this is a retrospective cohort analytical study. Demographic variables, comorbidities, severity scores such as APACHE II on admission, the worst oxygenation during hospitalization expressed by PaO2/FiO2, days of ventilation, prone position, tracheostomy, pharmacological and non-pharmacological therapeutic measures, days of hospitalization, as well as complications and mortality were recorded. Results: a total of 214 patients were included, 135 were admitted to mechanical ventilation (MRA), of which 58 (42.9%) developed VAP, with a median age of 52 years (40-60). VAP microorganisms were Gram-negative cocci in 98.3%, including Acinetobacter baumanii in 46.5%, Klebsiella pneumoniae in 22.8%, Pseudomona aeruginosa in 15.5%, and Stenotrophomona maltophilia in 5.2%. In-hospital mortality was 44.8%. Those under 50 years of age have a longer survival than those older (34 days vs. 22 days, with p of 0.026). Conclusion: the overall mortality rate was 44.8%. Age was an independent risk factor for mortality in patients with VAP, so healthcare professionals should be aware of the possibility of VAP in patients who require mechanical ventilation, especially in patients over 50 years of age.
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ABSTRACT Objective: this study aims to develop and validate the content and appearance of a bedside checklist for preventive care against Ventilator-Associated Pneumonia in adult Intensive Care Units. Method: a methodological research study was conducted from July 2022 to June 2023 in two phases: the development of the checklist and the validation of its content and appearance. The instrument was evaluated by 23 experts (nurses, physicians, physiotherapists, and dentists). The evaluation criteria focused on clarity and relevance, as well as the application of the Suitability Assessment of Materials, with scoring conducted using a Likert scale. Consensus among the experts was measured using the Content Validity Index, with items achieving over 80% agreement considered valid. Results: the first version of the instrument comprised four domains and 34 items. Following validation, modifications were made to three items, one domain was detached, and another was excluded due to an agreement score below 0.80. The final version of the checklist consists of four domains distributed across 22 items: three items in the Patient Identification domain, seven items in the Clinical Information domain, nine items in the Essential Practices domain, and three items in the Additional Approaches domain. The checklist demonstrated excellent internal consistency, with a Cronbach's alpha value of 0.972. Conclusion: the checklist was considered valid and could serve as an essential tool for preventing Ventilator-Associated Pneumonia in adult patients.
RESUMEN Objetivo: construir y validar el contenido y la apariencia de un checklist para la verificación a pie de cama de la atención preventiva de la Neumonía Asociada a la Ventilación en una Unidad de Cuidados Intensivos de adultos. Método: investigación metodológica, desarrollada de julio de 2022 a junio de 2023, en dos etapas: construcción del checklist y validación de contenido y apariencia. El instrumento fue sometido a evaluación por 23 especialistas (enfermeros, médicos, fisioterapeutas y odontólogos). Se evaluaron los criterios de claridad y pertinencia, así como la aplicación de la Suitability Assessment of Materials, con puntajes mediante una escala tipo Likert. El consenso entre los jueces se midió por medio del Índice de Validez de Contenido. Se consideró válido el ítem con más del 80% de acuerdo. Resultados: la primera versión del instrumento se construyó con cuatro dominios y 34 ítems. Luego de la validación se realizaron modificaciones en tres ítems, desvinculando un dominio y excluyendo otro por concordancia inferior a 0,80. Así, la versión final del checklist se compone de cuatro dominios distribuidos en 22 ítems, con tres ítems en el dominio de Identificación del Paciente, siete ítems en el dominio de Información Clínica, nueve ítems en el dominio de Prácticas Esenciales y tres ítems en el dominio de Enfoques Adicionales. El checklist presentó excelente consistencia interna, con un valor de 0,972 utilizando el Alfa de Cronbach.
RESUMO Objetivo: construir e validar o conteúdo e a aparência de um checklist para a verificação, à beira leito, de cuidados preventivos à Pneumonia Associada à Ventilação Mecânica em Unidade de Terapia Intensiva adulto. Método: pesquisa metodológica, desenvolvida no período de julho de 2022 a junho de 2023, em duas etapas: construção do checklist e validação do conteúdo e aparência. O instrumento foi submetido à avaliação de 23 especialistas (enfermeiros, médicos, fisioterapeutas e odontólogos). Avaliou-se os critérios de clareza e relevância, bem como a aplicação do Suitability Assessment of Materials, com pontuação por meio de escala do tipo Likert. O consenso entre os especialistas foi mensurado pelo Índice de Validade de Conteúdo. Considerou-se válido o item com mais de 80% de concordância. Resultados: a primeira versão do instrumento foi construída com quatro domínios e 34 itens. Após a validação, realizou-se modificações em três itens, desvinculação de um domínio e exclusão de outro domínio devido à concordância inferior a 0,80. Assim, a versão final do checklist está composta por quatro domínios distribuídos em 22 itens, sendo três itens no domínio Identificação do Paciente, sete itens do domínio Informações Clínicas, nove itens no domínio Práticas Essenciais e três itens no domínio Abordagens Adicionais. O checklist apresentou ótima consistência interna, com valor de 0,972 através do Alfa de Cronbach. Conclusão: o checklist foi considerado válido e a sua utilização pode contribuir como importante ferramenta para a prevenção da Pneumonia Associada à Ventilação Mecânica no paciente adulto.
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Objetivo: Evaluar el nivel de cumplimiento las medidas generales y específicas sobre la prevención de las neumonías asociadas a la ventilación mecánica del personal de enfermería en una unidad de cuidados intensivos. Metodología: Estudio cuantitativo, descriptivo y transversal. Participaron el total del personal de enfermería (n = 19) que trabaja en una Unidad de Cuidados Intensivos de un Hospital General de Zona, cargo de pacientes con ventilación mecánica, a quienes se les evaluó el cumplimiento de las acciones para la prevención de neumonía asociada a la ventilación mecánica y las barreras de seguridad durante los meses de junio y julio del 2024. Resultados: Predominaron la media de edad de 39 años (DE = 5,1), las mujeres (68,3 %), la Licenciatura en Enfermería con Postécnico en UCI (52,6 %) y turno matutino (31,6 %). De acuerdo con el cumplimiento de las recomendaciones: el 100 % realizó la posición semifowler y aspiración con técnica cerrada respectivamente, el 89,5 % aseo de cavidad oral, el 84,2 % interrupción de sedación y el 0% efectuó la humidificación activa o pasiva. Sobre acciones generales: el 68,4 % llevó a cabo los cinco momentos de la higiene de manos y el 78,9 % utilizó equipo de protección al momento de atender al paciente con ventilación. Conclusiones: Lograron un alto nivel de cumplimiento la mayoría de las recomendaciones para prevenir las neumonías a excepción de la humidificación activa o pasiva. Las medidas de barrera de seguridad tuvieron un bajo nivel de cumplimiento.
Objective: To evaluate the compliance level of nursing staff with general and specific measures for preventing ventilator-associated pneumonia in an intensive care unit. Methodology: This quantitative, descriptive, cross-sectional study included all nursing staff (n = 19) working in the ICU of a General Hospital, responsible for patients on mechanical ventilation. The compliance level with VAP prevention measures and safety barriers was assessed during June and July 2024. Results: The participants had a mean age of 39 years (SD = 5.1); the majority were women (68.3%), held a bachelor's degree in nursing with intensive care unit postgraduate training (52.6%), and worked morning shifts (31.6%). Regarding the compliance level with specific recommendations, 100% performed the semi-Fowler position and closed-system suctioning, 89.5% performed oral cavity hygiene, 84.2% implemented sedation interruption, and 0% conducted active or passive humidification. For general measures, 68.4% complied with the "five moments of hand hygiene," and 78.9% used personal protective equipment when caring for patients on mechanical ventilation. Conclusions: High compliance levels were observed for most ventilator-associated pneumonia prevention recommendations, except for active or passive humidification. However, compliance with safety barrier measures was low.
Objetivo: avaliar o nível de conformidade com medidas gerais e específicas sobre a prevenção de pneumonias associadas à ventilação mecânica entre a equipe de enfermagem em uma unidade de terapia intensiva. Metodologia: estudo quantitativo, descritivo e transversal. Toda a equipe de enfermagem (n = 19) que trabalha em uma Unidade de Terapia Intensiva de um Hospital de Área Geral, responsável por pacientes ventilados mecanicamente, que foram avaliados quanto à conformidade com ações para a prevenção de pneumonia associada à ventilação mecânica e barreiras de segurança durante os meses de junho e julho de 2024. Resultados: Idade média de 39 anos (DP = 5,1), sexo feminino (68,3 %), bacharelado em enfermagem com formação pós-técnica em UTI (52,6 %) e predomínio do turno da manhã (31,6 %). Em termos de cumprimento das recomendações: 100% realizaram a posição semi-fowler e a aspiração com técnica fechada, respectivamente, 89,5% realizaram a limpeza da cavidade oral, 84,2% interromperam a sedação e 0% realizaram a umidificação ativa ou passiva. Em relação às ações gerais: 68,4% realizaram todos os cinco momentos de higiene das mãos e 78,9% usaram equipamentos de proteção ao cuidar do paciente ventilado. Conclusões: Foi alcançado um alto nível de conformidade para a maioria das recomendações de prevenção de pneumonias, com exceção da umidificação ativa ou passiva. As medidas de barreira de segurança tiveram um baixo nível de conformidade.
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Introduction: Ventilator-associated pneumonia (VAP) is a serious health care-associated infection. It prolongs hospital stay and drives up hospital costs reporting high morbidity and mortality. VAP is de?ned as pneumonia that occurs 48h or more after endotracheal intubation or tracheostomy, caused by infectious agents not present or incubating at the time mechanical ventilation. VAP requires rapid diagnosis and initiation of the appropriate antibiotics. The present study was done in the department of Microbiology, Christian Medical College &Materials and Methods: Hospital, Ludhiana. All the clinically suspected cases of VAP from intensive care units over a period of one and a half year were included in the study. Endotracheal aspirate (ETA) and bronchoalveolar lavage (BAL) samples were collected from all patients and processed. Identi?cation was carried out according to standard biochemical tests. Sensitivity pattern was determined using Kirby-Bauer disc diffusion according to latest CLSI guidelines. Out of 125 patients, who were on mechanical ventilation, 36 were culture positive. We report an incidence of 27.2% VAP inResults: patients admitted at ICU. The major organisms isolated in the VAP patients were Acinetobacter spp. (58.82%), Klebsiella spp. (17.65%), Enterobacter spp. (14.71%), Pseudomonas spp. (8.82%), E. coli and non albicans Candida spp. (2.94%) each. Majority of the isolates were multi- drug resistant. All isolates combined; Metallo Beta Lactamase (MBL) producers were most common (60%). Even inDiscussion and Conclusion: the era of advanced medical care VAP remains a major challenge. The risk of developing VAP can be reduced by VAP prevention care bundles. Timely diagnosis is a major step to initiate appropriate antibiotics for better outcomes. Both patients and units are at risk of developing multidrug–resistant organisms and therefore appropriate antibiotic stewardship is essential. Better knowledge of local patterns of pathogens causing VAP can help facilitate treatment choice, in turn reducing the ventilator days and hospital stay.
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Fundamento: La salud bucal y sus cuidados son importantes en la atención sanitaria de pacientes en estado crítico. Objetivo: Proporcionar una visión general de los vínculos entre la salud bucal y los resultados adversos en la evolución de los pacientes en estado crítico. Metodología: Esta revisión narrativa se realizó en Google Académico, PubMed/Medline y SciELO, con los descriptores salud bucal, cuidados críticos, respiración artificial y neumonía asociada al ventilador, consultados en el DeCS. Se seleccionaron artículos a texto completo en español e inglés de revistas arbitradas por pares y de los últimos 5 años. Resultados: La disbiosis y la mala higiene bucales propician la aparición y desarrollo de enfermedades bucales que, a su vez, favorecen la incidencia de enfermedades respiratorias bajas como la neumonía asociada al ventilador en pacientes en estado crítico. Dentro de los factores vinculantes están la aspiración de secreciones bucales con bacterias patógenas que colonizan el tracto respiratorio inferior y los trastornos nutricionales que reducen el sistema defensivo. Aunque existen algunas discrepancias, la mayoría de los estudios apoyan las medidas de cuidado bucal en los pacientes en estado crítico. Conclusiones: La salud y cuidados bucales son claves para un desenlace clínico más favorable en los pacientes en estado crítico.
Background: Oral health and oral health care are important in the health care of critically ill patients. Objective: To provide an overview of the relationship between oral health and adverse outcomes in critically ill patients. Methodology: This narrative revision was conducted in Google Scholar, PubMed/Medline and SciELO, with the descriptors oral health, critical care, artificial respiration and ventilator-associated pneumonia consulted in the DeCS. Full-text articles in Spanish and English from peer-reviewed journals and from the last 5 years were selected. Results: Dysbiosis and poor oral hygiene promote the incidence and development of oral diseases, which in turn promote the incidence of lower respiratory system diseases such as ventilator-associated pneumonia in critically ill patients. Among the factors involved are aspiration of oral secretions with pathogenic bacteria that colonize the lower respiratory tract, and nutritional deficiencies that compromise the immune system. Although there are some discrepancies, most studies support oral care practices in critically ill patients. Conclusions: The health and care of the oral cavity is the key to a more favorable outcome for critically ill patients.
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Health care–associated infections (HAI) directly influence the survival of children in pediatric intensive care units (PICU), the most common being central line–associated bloodstream infection (CLABSI) 25–30%, followed by ventilator-associated pneumonia (VAP) 20–25%, and others such as catheter-associated urinary tract infection (CAUTI) 15%, surgical site infection (SSI) 11%. HAIs complicate the course of the disease, especially the critical one, thereby increasing the mortality, morbidity, length of hospital stay, and cost. The incidence of HAI in Western countries is 6.1–15.1% and in India, it is 10.5 to 19.5%. The advances in healthcare practices have reduced the incidence of HAIs in the recent years which is possible due to strict asepsis, hand hygiene practices, surveillance of infections, antibiotic stewardship, and adherence to bundled care. The burden of drug resistance and emerging infections are increasing with limited antibiotics in hand, is still a dreadful threat. The most common manifestation of HAIs is fever in PICU, hence the appropriate targeted search to identify the cause of fever should be done. Proper isolation practices, judicious handling of devices, regular microbiologic audit, local spectrum of organisms, identification of barriers in compliance of hand hygiene practices, appropriate education and training, all put together in an efficient and sustained system improves patient outcome.
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SUMMARY OBJECTIVE: The aim of this study was to evaluate the combination treatments with intravenous fosfomycin for carbapenem-resistant Klebsiella pneumoniae infections in a tertiary-care center. METHODS: Between December 24, 2018 and November 21, 2022, adult patients diagnosed with bloodstream infection or ventilator-associated pneumonia due to culture-confirmed carbapenem-resistant Klebsiella pneumoniae in the anesthesiology and reanimation intensive care units were investigated retrospectively. RESULTS: There were a total of 62 patients fulfilling the study inclusion criteria. No significant difference was recorded in 14- and 30-day mortality among different types of combination regimens such as fosfomycin plus one or two antibiotic combinations. Hypokalemia (OR:5.651, 95%CI 1.019-31.330, p=0.048) was found to be a significant risk factor for 14-day mortality, whereas SOFA score at the time of diagnosis (OR:1.497, 95%CI 1.103-2.032, p=0.010) and CVVHF treatment (OR:6.409, 95%CI 1.395-29.433, p=0.017) were associated with 30-day mortality in multivariate analysis. CONCLUSION: In our study, high mortality rates were found in patients with bloodstream infection or ventilator-associated pneumonia due to carbapenem-resistant Klebsiella pneumoniae, and no significant difference was recorded in 14- and 30-day mortality among different types of combination regimens such as fosfomycin plus one or two antibiotic combinations.
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Objective:To develop a prone position management program and evaluate its effectiveness in preventing ventilator-associated pneumonia (VAP) in children with congenital heart disease combined with acute respiratory distress syndrome, in order to provide experience for clinical application.Methods:This was a quasi-experimental study. Convenient sampling method was used to select children with congenital heart defect who underwent mechanical ventilation in the Cardiothoracic Surgical Care Unit of Shanghai Children′s Medical Center, Shanghai Jiao Tong University, School of Medicine from June 2018 to December 2021 as the study subjects. The control group consisted of 80 hospitalized children from June 2018 to December 2019. They were used general nursing interventions to prevent VAP. The 42 hospitalized children from January 2020 to December 2021 were the intervention group, who usd the prone position management program on the basis of the control group. The differences in the incidence of VAP, duration of mechanical ventilation, duration of ICU stay, oxygenation index and the incidence of adverse events between the two groups were compared.Results:The incidence of VAP and mechanical ventilation duration in the intervention group were 4.8% (2/42) and 67.50 (55.00/101.50), which were lower than 35.0% (28/80) and 92.50 (68.00/142.00) of the control group, and the differences were statistically significant ( χ2=11.98, Z=3.40, both P<0.01). And the trend of increasing oxygenation index with the intervention group was better than the control group ( F=8.38, P<0.05). There was no statistical difference in the incidence of adverse events between the two groups (all P>0.05). Conclusions:The application of prone ventilation program with congenital heart disease children complicated with acute respiratory distress syndrome is safe and can significantly improve the oxygenation index, shorten the duration of mechanical ventilation and reduce the incidence of VAP.
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Respiratory microbiome is extensively involved in human life activities and affects lung health and disease states through metabolism and immune regulation. Based on 16S rRNA gene sequencing and other methods, it is obvious that the diversity and the changes in the structure of respiratory microbiome and the dominant proliferation of pathogens are strongly related to the occurrence, development and clinical prognosis of ventilator-associated pneumonia (VAP). The mechanism by which respiratory microbiota promotes the clearance of pathogens may include the following aspects: ① pre-stimulating innate immune system to increase the number of immune effector cells; ② regulating pattern recognition receptor (PRR) to moderately promote the production of cytokines; ③ inducing the differentiation of neutrophils into specific subtypes and increasing the expression of antimicrobial genes; ④ producing free fatty acids and organic compounds that are capable of positively modulating the immune system. In conclusion, intervention of microbiome is beneficial to VAP patients. Therefore, this review illustrates the changes of respiratory flora in VAP and its effect on host immunity. At the same time, based on the review of the adjuvant treatment of VAP with probiotics, we put forward the prospect of respiratory commensal bacteria as a new clinical probiotic, in order to deepen the clinical understanding of the role of respiratory flora in VAP, and then provide new ideas for the evaluation of treatment and prognosis.
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Objective To investigate the nursing clinical practice of ICU ventilator-associated pneumonia(VAP)prevention and control of tertiary hospitals in China,and analyze relevant countermeasures.Methods A self-designed questionnaire consisted of 3 parts and 26 items.A questionnaire survey was conducted among nurses in 380 ICUs in 194 tertiary hospitals in 26 provinces from September 1 to 15,2021,using the convenient sampling method.Results A total of 380 valid questionnaires were collected,with an effective rate of 100%.In the system process,369(97.11%)ICUs had files to prevent VAP;291(76.58%)ICUs had a checklist of measures to prevent VAP clustering;274(72.11%)ICUs had continuous improvement projects about VAP in the last 3 years.In the aspect of body position management,semi-decubitus position was the first choice for the patients with invasive mechanical ventilation of 338(88.95%)ICUs.For nursing operation,224(58.95%)ICUs used Subglottic suction,and 128(33.68%)among them used air shock to remove the retention on the balloon;normal saline is still routinely injected before sputum aspiration in 72(18.95%)ICUs.In terms of balloon pressure monitoring,253(66.58%)ICUs did the oral care 3-4 times a day.In the balloon pressure monitoring,313(82.37%)ICUs use airbag pressure gauges to intermittently monitor airbag pressure;293(77.11%)ICUs replaced the ventilator pipeline once a week.There are significant differences in the current practice status of different types of ICUs in terms of compliance strategies for bed head lifting,subglottic secretion drainage,airbag pressure monitoring,and oral care(P<0.05).Conclusion At present,the relevant systems and procedures to prevent VAP have been improved,but the specific prevention and control measures need to be further unified.Therefore,it is suggested to analyze the weak links of VAP nursing prevention and control practice in various medical structures,carry out relevant training and quality control for the weak links,and further improve the working mechanism of continuous quality improvement,thus effectively reduce the incidence of VAP.
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ABSTRACT Introduction: Risk factors and postoperative complications can worsen the condition of patients undergoing coronary artery bypass grafting; some of these factors and complications are closely related to mortality rate. Objective: To describe clinical factors and outcomes related to mortality of patients undergoing coronary artery bypass grafting and on invasive mechanical ventilation. Methods: This is a single-center retrospective data analysis of patients who underwent coronary artery bypass grafting on invasive mechanical ventilation between 2013 and 2019. Data regarding clinical characteristics, postoperative complications, intensive care unit and mechanical ventilation time, and their relationship with mortality were analyzed. Results: Four hundred seventy-two patients who underwent coronary artery bypass grafting entered the study. Their mean age was 62.3 years, and mean body mass index was 27.3. The mortality rate was 4%. Fifty percent of the patients who had ventilator-associated pneumonia died. Considering the patients who underwent hemotherapy and hemodialysis, 20% and 33% died, respectively. Days of intensive care unit stay and high Acute Physiology and Chronic Health Evaluation score and Simplified Acute Physiology Score were significantly related to death. Conclusion: Factors and clinical conditions such as the patients' age, associated comorbidities, the occurrence of ventilator-associated pneumonia, length of stay in the intensive care unit, and mechanical ventilation time are related to higher mortality in patients undergoing coronary artery bypass grafting.
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Background:Ventilator?associated pneumonia (VAP) with multidrug?resistant (MDR) gram negative organisms is a common problem in intensive care unit (ICU). Aerosolized antibiotics enhance the efficacy of systemic antibiotics when added as adjuvants. Aim: The primary objective of the study was to compare the clinical and bacteriological outcome of patients with VAP who were administered intravenous (IV) antibiotics alone with those patients who were treated with adjunctive nebulized colistin (NC) along with IV antibiotics. The secondary objective was to study the occurrence of any adverse events during colistin nebulization. Settings and Design: The study was a prospective, randomized, double?blinded controlled study conducted at a tertiary?care teaching institution. Materials and Methods: Ninety?eight children from surgical ICU aged less than 12 years who were diagnosed with VAP due to gram negative bacteria following cardiac surgery were chosen and divided randomly into two groups. The experimental group (NC group) was treated with systemic antibiotics along with NC, whereas the control group (NS group) was administered systemic antibiotics with nebulized normal saline (NS). Clinical and bacteriological outcomes were noted. Statistical analysis was done using SPSS Version 20.0 software. The patient characteristics were compared using independent Student’s t test and Chi?square test. Results: There was a statistically significant reduction in the duration of mechanical ventilation, postoperative ICU and hospital stay (P < 0.05) in the NC group compared with the NS group. Conclusion: Aerosolized colistin may be considered as an adjunct to systemic IV antibiotics in pediatric patients with VAP due to gram negative bacteria susceptible to colistin.
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Background and Objectives: to assess the epidemiological profile of patients diagnosed with ventilator-associated pneumonia (VAP) in an Intensive Care Unit (ICU) and to investigate nursing care adequacy. Methods: a quantitative retrospective cohort study, applied in the ICU of a hospital in the countryside of Rio Grande do Sul. It involved 100% of medical records of patients over 20 years of age, in the year 2019, who developed VAP. Results: a total of 3,215 patients were on invasive mechanical ventilation (IMV), and of these 13 developed VAP (2.47%). Most were men (76.92%), with a mean age of 60.3 years, whose main causes of hospitalization were heart problems (30.77%), multiple trauma (30.77%) and stroke (15.39%). The main pathogens found in tracheal aspirates were Acinetobacter sp. (15%) and Pseudomonas aeruginosa (15%). The mean ICU stay was 30.61 days, and 61.53% died. For nursing care assessment, the mean checklist of the VAP bundle applied was calculated, according to the number of days in VMI. The result was 2.62 checklists per day, with the institution recommending four. Conclusion: the study made it possible to know the epidemiological profile of patients with VAP, in addition to observing the need for improvement in nursing care, considering that the checklist completion was below the recommended.(AU)
Justificativa e Objetivos: avaliar o perfil epidemiológico de pacientes diagnosticados com pneumonia associada à ventilação mecânica (PAVM) em Unidade de Terapia Intensiva (UTI) e investigar a adequação dos cuidados de enfermagem. Métodos: estudo quantitativo de coorte, retrospectivo, aplicado na UTI de um hospital do interior do Rio Grande do Sul. Envolveu 100% dos prontuários de pacientes com mais de 20 anos de idade, no ano de 2019, que desenvolveram PAVM. Resultados: estiveram em ventilação mecânica invasiva (VMI) 3.215 pacientes e, desses, 13 desenvolveram PAVM (2,47%). A maioria era homens (76,92%), com média de idade de 60,3 anos, cujas principais causas de internação foram problemas cardíacos (30,77%), politraumatismo (30,77%) e acidente vascular cerebral (15,39%). Os principais patógenos encontrados nos aspirados traqueais foram Acinetobacter sp (15%) e Pseudomonas aeruginosa (15%). A média de permanência na UTI foi de 30,61 dias, e foram a óbito 61,53%. Para avaliação dos cuidados de enfermagem, foi calculada a média de checklist do bundle de PAVM, aplicados, conforme a quantidade de dias em VMI. O resultado foi de 2,62 checklists por dia, sendo que a instituição preconiza quatro. Conclusão: o estudo permitiu conhecer o perfil epidemiológico dos pacientes com PAVM, além de observar a necessidade de melhora nos cuidados de enfermagem, considerando que a realização do checklist ficou abaixo do recomendado.(AU)
Justificación y Objetivos: evaluar el perfil epidemiológico de pacientes con diagnóstico de neumonía asociada a ventilación mecánica (NAVM) en una Unidad de Cuidados Intensivos (UCI) e investigar la adecuación de los cuidados de enfermería. Métodos: estudio de cohorte cuantitativo, retrospectivo, aplicado en el UCI de un hospital del interior de Rio Grande do Sul. Involucró el 100% de las historias clínicas de pacientes mayores de 20 años, en el año 2019, que desarrollaron NAVM. Resultados: un total de 3.215 pacientes estaban en ventilación mecánica invasiva (VMI), y, de estos, 13 desarrollaron NAVM (2,47%). La mayoría eran hombres (76,92%), con una edad media de 60,3 años, cuyas principales causas de hospitalización fueron problemas cardíacos (30,77%), politraumatismos (30,77%) y accidentes cerebrovasculares (15,39%). Los principales patógenos encontrados en los aspirados traqueales fueron Acinetobacter sp (15%) y Pseudomonas aeruginosa (15%). La estancia media en UCI fue de 30,61 días, y falleció el 61,53%. Para la evaluación de la atención de enfermería, se calculó el checklist promedio del bundle VAP aplicado, de acuerdo con el número de días en VMI. El resultado fue de 2,62 checklists por día, y la institución recomendó cuatro. Conclusión: el estudio posibilitó conocer el perfil epidemiológico de los pacientes con NAVM, además de observar la necesidad de mejoría en la atención de enfermería, considerando que el llenado del checklist estuvo por debajo de lo recomendado.(AU)