Valoración de los cuidados de enfermería en la prevención de la neumonía asociada a ventilación mecánica / Nursing care in the prevention of ventilator-associated pneumonia

IntroducciónDeterminados cuidados de enfermería disminuyen la incidencia de neumonía asociada a ventilación mecánica (NAVM).Objetivosa) analizar, en pacientes con más de 24h de ventilación mecánica invasiva (VMI), la frecuencia de realización de higiene bucal, aspiración orofaríngea, cambios posturales y valoración de la tolerancia a la nutrición enteral (NE), según lo establecido en los protocolos; b) registrar, en pacientes con más de 24h de VMI, los grados de elevación de la cabecera de la cama y la presión del neumotaponamiento del tubo endotraqueal, y c) determinar, en los 3 meses de estudio, la densidad de incidencia de neumonía asociada a VMI.MétodoEsta investigación descriptiva se realizó en 26 pacientes. Diariamente se recogían los cuidados estudiados, registrados como realizados por las enfermeras. Además, se medían 3 veces/día la presión del neumotaponamiento y los grados de elevación de la cabecera de la cama. Se consideró un buen cumplimiento de los protocolos de cuidados cuando su frecuencia de realización era ≥ 80% de lo establecido. Los casos de NAVM se determinaron según la CDC; para calcular la densidad de incidencia se incluyó a todos los pacientes (122) con VMI durante el periodo de estudio.ResultadosSe obtuvo buen cumplimiento de los protocolos en higiene bucal en 23 pacientes; en aspiración orofaríngea y cambios posturales, en 19, y en todos los pacientes en la valoración de la tolerancia de la NE. Presión (..) (AU)

IntroductionCertain nursing interventions reduce the incidence of ventilator-associated pneumonia (VAP).Objectivesa) to analyze in patients with more than 24 hours of invasive mechanical ventilation how frequently oral hygiene, oropharyngeal suction, turning and evaluation of the tolerance of enteral nutrition were performed according to established protocols; b) to record in these same patients endotracheal tube cuff pressures and the degrees of elevation of the head of the bed (HOB); c) to determine over the three months of the study the incidence density of VAP.MethodThis descriptive study was carried out in 26 patients. The nursing interventions of interest were recorded daily. Furthermore, endotracheal tube cuff pressures and the degrees of elevation of HOB were measured 3 times a day. Compliance with the established protocols was considered good when it reached ≥80%. Cases of VAP were determined using CDC criteria. The incidence density was calculated including all the patients (122) with mechanical ventilation during the study period.ResultsGood compliance with the established protocols was achieved for oral hygiene in 23 patients, for oropharyngeal suction and for turning in 19 patients, and in all patients for the evaluation of the tolerance of enteral nutrition. In 214 measurements endotracheal tube cuff pressure was ≥ 20cm H20 and in 121 lower. In 79 measurements elevation of HOB was ≥30̊ and in 256 lower. The incidence density of VAP was 7.43/ 1.000 days of mechanical ventilation.Conclusions: For these nurse interventions aimed at preventing VAP, levels of compliance with established protocols were satisfactory. The incidence density of VAP was low and well within internationally established ranges. Nevertheless, the incidence of VAP could be further reduced with a better control of cuff pressures and by elevating the HOB to between 30̊ and 45̊ (AU)

[Nursing care in the prevention of ventilator-associated pneumonia]. / Valoración de los cuidados de enfermería en la prevención de la neumonía asociada a ventilación mecánica.

INTRODUCTION: Certain nursing interventions reduce the incidence of ventilator-associated pneumonia (VAP). OBJECTIVES: a) to analyze in patients with more than 24 hours of invasive mechanical ventilation how frequently oral hygiene, oropharyngeal suction, turning and evaluation of the tolerance of enteral nutrition were performed according to established protocols; b) to record in these same patients endotracheal tube cuff pressures and the degrees of elevation of the head of the bed (HOB); c) to determine over the three months of the study the incidence density of VAP. METHOD: This descriptive study was carried out in 26 patients. The nursing interventions of interest were recorded daily. Furthermore, endotracheal tube cuff pressures and the degrees of elevation of HOB were measured 3 times a day. Compliance with the established protocols was considered good when it reached ≥80%. Cases of VAP were determined using CDC criteria. The incidence density was calculated including all the patients (122) with mechanical ventilation during the study period. RESULTS: Good compliance with the established protocols was achieved for oral hygiene in 23 patients, for oropharyngeal suction and for turning in 19 patients, and in all patients for the evaluation of the tolerance of enteral nutrition. In 214 measurements endotracheal tube cuff pressure was ≥ 20cm H20 and in 121 lower. In 79 measurements elevation of HOB was ≥30° and in 256 lower. The incidence density of VAP was 7.43/ 1.000 days of mechanical ventilation. CONCLUSIONS: : For these nurse interventions aimed at preventing VAP, levels of compliance with established protocols were satisfactory. The incidence density of VAP was low and well within internationally established ranges. Nevertheless, the incidence of VAP could be further reduced with a better control of cuff pressures and by elevating the HOB to between 30° and 45°.