A review of oral preventative strategies to reduce ventilator-associated pneumonia.

AIM: This article evaluates the evidence for and efficacy of the use of mechanical hygiene and chlorhexidine in the prevention of ventilator-associated pneumonia (VAP). INCLUSION CRITERIA: primary research articles; randomized controlled trials; systematic reviews. EXCLUSION CRITERIA: quasi-experimental trials; opinion articles. Search Engines: PubMed; CINAHL; and EBSCO. BACKGROUND: VAP is the commonest infection found in critically ill patients who are mechanically ventilated. It is associated with increased mortality, increased length of stay in intensive care and increased costs. RELEVANCE TO CLINICAL PRACTICE: VAP is a health care-associated infection consistent with the presence of an endotracheal tube and mechanical ventilation for greater than 48 h. Efforts aimed at reducing infection rates include oral decontamination and mechanical hygiene to control the bacteria responsible, since there is an association between changes in bacteria found in the oropharynx and its development. Tooth brushing and the use of an oral antiseptic such as chlorhexidine gluconate are increasingly recommended in ventilator care bundles. CONCLUSION: While there have been a number of studies conducted evaluating the efficacy of both approaches, there is limited evidence to support their use. The frequency of oral decontamination and mechanical hygiene interventions have not been established and chlorhexidine 2% seems to be more effective compared to weaker concentrations, but data is mainly confined to patients following cardiothoracic surgery.

Prevention of deterioration in acutely ill patients in hospital.

The shift towards providing critical care in general wards has changed the way acutely ill patients are identified, treated and managed in hospital. This requires the expertise of knowledgeable, informed and capable staff. Effective education and appropriate knowledge and skills are required to aid identification of the deteriorating patient and provide prompt, timely and appropriate intervention to prevent further deterioration and possibly death. This article provides information about a systematic approach that will enable healthcare professionals to intervene to prevent deterioration in acutely ill patients.

Developments in the management of patients with sepsis.

Sepsis is associated with a high incidence of mortality and morbidity, however with appropriate strategies for monitoring and early targeted intervention mortality rates decline. This article examines the basic pathophysiology of the inflammatory response to tissue injury and the effects this has on circulation. A partnership of the Society of Critical Care Medicine, the European Society of Intensive Care Medicine and the International Sepsis Forum has developed the surviving sepsis strategy, which includes the sepsis six treatment pathway and early goal-directed therapy incorporating the six-hour care bundle.

Critical illness polyneuromyopathy (CIPNM); rehabilitation during critical illness. Therapeutic options in nursing to promote recovery: a review of the literature.

Following critical illness requiring prolonged mechanical ventilation and sedation, intensive care patients often present with neuromuscular weakness. This results from critical illness polyneuropathy (CIP) and critical illness myopathy (CIM). A lack of diagnostic criteria for each syndrome complicates prevention and treatment. Consequently the term critical illness polyneuromyopathy (CIPNM) has emerged and is characterised by severe weakness, reduced or absent limb reflexes and marked muscle wasting. Although clinical trials report a high incidence of CIPNM, in clinical practice it often remains undetected. The pathophysiological mechanisms that lead to neuromuscular weakness are not entirely clear, however several risk factors have been identified and will be discussed. To date, there are no specific treatments or interventions available to reduce the onset or impact of CIPNM. This paper will review the strategies employed that are supportive and aimed at controlling the associated risk factors.

Teaching pre-registration student nurses to assess acutely ill patients: an evaluation of an acute illness management programme.

Mortality and physical crisis in hospital can be prevented by accurate assessment and early intervention. Evidence suggests that patients experiencing acute illness outside critical care areas who receive enhanced levels of intervention from appropriately trained nurses prevent the need for admission to high dependency and intensive care beds. Such interventions can lead to reduced mortality and morbidity. This qualitative study, supported by quantitative assessment, evaluated training for student nurses designed to assess patients using a structured programme in the management of acute illness. Questionnaires were used to collect data from 184 third year nursing students eliciting their experiences of the training programme. The responses demonstrated a positive evaluation of the programme. The study has implications for incorporating acute illness assessment into a theoretically oriented curriculum. Exposing student nurses to the programme enhances teaching and learning, as well as having potential for more effective interventions to take place in practice.