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Dewi YS, Arifin H, Pradipta RO, Qona’ah A, Rosita R, Giatin CN, Dawod Kamel Gauda A. RETRACTED: Dewi et al. Efficacy of Intermittent and Continuous Subglottic Secretion Drainage in Preventing the Risk of Ventilator-Associated Pneumonia: A Meta-Analysis of Randomized Control Trials. Medicina 2023, 59, 283. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1900. [PMID: 38004097 PMCID: PMC10672777 DOI: 10.3390/medicina59111900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 11/26/2023]
Abstract
The journal retracts the article entitled "Efficacy of Intermittent and Continuous Subglottic Secretion Drainage in Preventing the Risk of Ventilator-Associated Pneumonia: A Meta-Analysis of Randomized Control Trials" [...].
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Affiliation(s)
- Yulis Setiya Dewi
- Faculty of Nursing, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Hidayat Arifin
- Faculty of Nursing, Universitas Airlangga, Surabaya 60115, Indonesia
- School of Nursing, College of Nursing, Taipei Medical University, Taipei 110, Taiwan
- Palembang MediRose Publisher, Palembang 30154, Indonesia
| | | | - Arina Qona’ah
- Faculty of Nursing, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Rosita Rosita
- Faculty of Nursing, Universitas Airlangga, Surabaya 60115, Indonesia
| | | | - Amel Dawod Kamel Gauda
- Maternal and Newborn Health Nursing, College of Nursing, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of the National Guard, Riyadh 11173, Saudi Arabia;
- Department of Maternal and Newborn Health Nursing, Faculty of Nursing, Cairo University, Cairo 11562, Egypt
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Patel N, Lin P, Stack M, Conrad JM, Fakioglu H, Abomoelak B, Horvath K, Mehta DI. Oral Care Associated With Less Microaspiration in Ventilated Cardiac Patients. JPGN REPORTS 2023; 4:e290. [PMID: 37181916 PMCID: PMC10174743 DOI: 10.1097/pg9.0000000000000290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 09/08/2022] [Indexed: 05/16/2023]
Abstract
Aspiration is common in mechanically ventilated patients and may predispose patients to aspiration pneumonia, chemical pneumonitis, and chronic lung damage. Pepsin A is a specific marker of gastric fluid aspiration and is often detected in ventilated pediatric patients. We investigated the effect of oral care and throat suctioning in the detection of pepsin A in tracheal aspirates (TAs) up to 4 hours after these procedures. Methods Twelve pediatric patients between age 2 weeks to 14 years who underwent intubation for cardiac surgery were enrolled in this study. Six of the 12 patients were consented before their surgery with initial specimen collected at the time of intubation and last one shortly before extubation (intubation duration < 24 hours). The remaining 6 patients were consented after cardiac surgery. All specimens were collected per routine care per respiratory therapy protocol and shortly before extubation (intubation duration > 24 hours). Tracheal fluid aspirates were collected every 4 to 12 hours in the ventilated patients. Enzymatic assay for gastric pepsin A and protein determination were performed. The time of oral care and throat suctioning within 4 hours prior was recorded prospectively. Results A total of 342 TA specimens were obtained from the 12 intubated pediatric patients during their course of hospitalization; 287 (83.9%) showed detectable total pepsin (pepsin A and C) enzyme activity (> 6 ng/mL) and 176 (51.5%) samples had detectable pepsin A enzyme levels (>6 ng/mL of pepsin A). Only 29 samples of 76 samples (38.2%) had evidence of microaspiration after receiving oral care, while 147 of 266 (55.3%) samples were pepsin A positive when no oral care was provided. Odds ratio is 0.50 (Cl 0.30-0.84), and the number needed to treat is 5.8 (Confidence interval 3.4-22.3). Testing air filters for pepsin was not beneficial. Conclusion Oral care is a highly effective measure to prevent microaspiration of gastric fluid in ventilated pediatric patients. The number needed to treat (5.8) suggests this is a very effective prevention strategy. Our study suggests that pepsin A is a useful and sensitive biomarker that allows identification of gastric aspiration.
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Affiliation(s)
- Nishant Patel
- From the Center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, Orlando, FL
| | - Philip Lin
- From the Center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, Orlando, FL
| | - Michael Stack
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - Janet M. Conrad
- Pediatric Gastroenterology and Translational Research Laboratory, Cardiology Arnold Palmer Hospital for Children, Orlando, FL
| | - Harun Fakioglu
- Department of Pediatric Cardiology Arnold Palmer Hospital for Children, Orlando, FL
| | - Bassam Abomoelak
- Pediatric Gastroenterology and Translational Research Laboratory, Cardiology Arnold Palmer Hospital for Children, Orlando, FL
| | - Karoly Horvath
- From the Center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, Orlando, FL
| | - Devendra I. Mehta
- From the Center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, Orlando, FL
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Dewi YS, Arifin H, Pradipta RO, Qona’ah A, Rosita R, Giatin CN, Dawod Kamel Gauda A. Efficacy of Intermittent and Continuous Subglottic Secretion Drainage in Preventing the Risk of Ventilator-Associated Pneumonia: A Meta-Analysis of Randomized Control Trials. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:283. [PMID: 36837483 PMCID: PMC9959238 DOI: 10.3390/medicina59020283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/20/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023]
Abstract
Ventilator-associated pneumonia (VAP) is hospital-acquired pneumonia that develops 48 h or longer following mechanical ventilation. However, cuff pressure fluctuates significantly due to patient or tube movement, which might result in microaspiration. Subglottic secretion drainage (SSD) has been suggested as a method for VAP prevention bundles. This systematic review and meta-analysis aims to investigate the efficacy and safety of subglottic SSD in preventing VAP. The secondary outcomes of this study are to investigate the intensive care unit (ICU) stay length and mortality rate regarding VAP. This study followed the Preferred Reporting Item for Systematic Review and Meta-Analysis guidelines. A thorough search of PubMed, Embase, and the Web of Science was conducted between June and August 2022. The study analysis used the Mantel-Haenszel method, and the quality of the included study was assessed using the Cochrane Risk of Bias 2. Eighteen randomized controlled trials with a total of 2537 intubated patients were included. It was found that SSD was associated with a lower risk of VAP (RR 1.44; 95% CI; 1.20-1.73; p < 0.0001). The subgroup analysis (utilizing intermittent and continuous methods) found no statistically significant difference between the two groups (p = 0.28). The secondary endpoints showed that there was no significant difference in mortality (RR 1.02; 95% CI; 0.87-1.20; p = 0.83), but there were substantial differences in ICU stays (mean difference, 3.42 days; 95% CI; 2.07-4.76; p < 0.00001) in favor of the SSD group. This was based on a very low certainty of evidence due to concerns linked to the risk of bias and inconsistency. The use of SSD was associated with a reduction in VAP incidence and ICU stay length, but there was no significant difference in the mortality rate.
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Affiliation(s)
- Yulis Setiya Dewi
- Faculty of Nursing, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Hidayat Arifin
- Faculty of Nursing, Universitas Airlangga, Surabaya 60115, Indonesia
- School of Nursing, College of Nursing, Taipei Medical University, Taipei 110, Taiwan
- Palembang MediRose Publisher, Palembang 30154, Indonesia
| | | | - Arina Qona’ah
- Faculty of Nursing, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Rosita Rosita
- Faculty of Nursing, Universitas Airlangga, Surabaya 60115, Indonesia
| | | | - Amel Dawod Kamel Gauda
- Maternal and Newborn Health Nursing, College of Nursing, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of the National Guard, Riyadh 11173, Saudi Arabia
- Department of Maternal and Newborn Health Nursing, Faculty of Nursing, Cairo University, Cairo 11562, Egypt
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Muacevic A, Adler JR, Jinta T, Okamoto H. Isolation of Patients With Bacterial Pneumonia Suspected of COVID-19 Leads to Prolonged Hospitalization. Cureus 2022; 14:e32155. [PMID: 36601149 PMCID: PMC9807084 DOI: 10.7759/cureus.32155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 12/05/2022] Open
Abstract
Objective The coronavirus disease 2019 (COVID-19) pandemic has changed the inpatient treatment practice for bacterial pneumonia. Upon hospitalization, isolation is required while waiting for the polymerase chain reaction (PCR) test result, which may lead to limited access to medical resources and fewer room visits by medical staff. However, little is known about the relationship between isolation and the clinical outcomes of bacterial pneumonia. We hypothesized that isolation of suspected COVID-19 patients who are eventually diagnosed with bacterial pneumonia is associated with a prolonged length of hospitalization as compared with non-isolation. Patients This is a single-center, retrospective observational study of hospitalized adult patients diagnosed with bacterial pneumonia from January 2018 to September 2021. The patients were divided into a non-isolated (patients hospitalized between January 2018 and December 2019, who were not isolated at all) and an isolated group (patients hospitalized between January 2020 and September 2021, who were initially isolated because COVID-19 was suspected). The primary outcome was a prolonged length of hospitalization (≥14 days), and its relationship with isolation was analyzed using logistic regression analysis adjusted for age, sex, CURB-65, and the Charlson Comorbidity Index. Results Among 917 eligible patients, 214 (23%) underwent isolation. In the logistic regression analysis, the isolated group independently had a prolonged length of hospitalization as compared with the non-isolated group (odds ratio 1.49; 95% confidence interval 1.08-2.07, p=0.015). There was no significant difference in antibiotic use duration between the groups. Conclusion The isolation of bacterial pneumonia patients suspected of COVID-19 was associated with prolonged length of hospitalization.
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Jalal SM, Alrajeh AM, Al-Abdulwahed JAA. Performance Assessment of Medical Professionals in Prevention of Ventilator Associated Pneumonia in Intensive Care Units. Int J Gen Med 2022; 15:3829-3838. [PMID: 35418777 PMCID: PMC9000598 DOI: 10.2147/ijgm.s363449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/29/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose Ventilator-associated pneumonia (VAP) is one of the most common infections in intensive care units (ICU) with a 6–52% incidence. The VAP mortality rate is 50% to 70%. Medical professionals (MPs) working in the ICU are expected to follow the guidelines to prevent VAP. The study aimed to assess the performance of MPs in preventing VAP and to associate the performance with the baseline information. Methods An observational cross-sectional study was conducted in the ICUs of selected hospitals in eastern Saudi Arabia. A total of 152 MPs were selected by random sampling. A structured questionnaire including baseline information, knowledge and performance-related questions was used to collect the data. Frequency, mean, and chi-square tests were used for analysis. Results Out of 152 MPs, 40.8% had adequate and 7.9% had inadequate knowledge. A high mean score of 12.9 ± 2.2 was obtained by physicians, followed by 11.3 ± 1.6 by nurses, 9.8 ± 2.2 by RTs, and 8.6 ± 2.1 by interns. Overall, 52.6% had satisfactory performance. Approximately 57.9% and 67.8% of MPs cleaned their hands before touching the patient and the ventilator, respectively. Many (79.6%) MPs used personal protective equipment in the ICU. Some (47.4%) of the MPs changed the patient’s position regularly. About 77.6% of MPs followed the sterile technique when suctioning the airway. There was a significant association found between the performance of MPs on the prevention of VAP with age (p < 0.001), designation (p < 0.05), professional experience (p < 0.05), managing chronic obstructive pulmonary disease conditions (p < 0.05) and training attended (p < 0.001). Conclusion Although some of the MPs had satisfactory performance regarding VAP prevention in the ICU, more attention should be paid to training them on clinical guidelines to improve health care quality and reduce the rate of VAP.
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Affiliation(s)
- Sahbanathul Missiriya Jalal
- Department of Nursing, College of Applied Medical Sciences, King Faisal University, Al-Ahsa, 31982, Saudi Arabia
- Correspondence: Sahbanathul Missiriya Jalal, Department of Nursing, College of Applied Medical Sciences, King Faisal University, Al-Ahsa, 31982, Saudi Arabia, Tel +966564070973, Email
| | - Ahmed Mansour Alrajeh
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Faisal University, Al-Ahsa, 31982, Saudi Arabia
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Sole ML, Talbert S, Yan X, Penoyer D, Mehta D, Bennett M, Emery KP, Middleton A, Deaton L, Abomoelak B, Deb C. Impact of deep oropharyngeal suctioning on microaspiration, ventilator events, and clinical outcomes: A randomized clinical trial. J Adv Nurs 2019; 75:3045-3057. [PMID: 31241194 PMCID: PMC8331062 DOI: 10.1111/jan.14142] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/18/2019] [Accepted: 06/13/2019] [Indexed: 12/12/2022]
Abstract
AIMS To evaluate a deep oropharyngeal suction intervention (NO-ASPIRATE) in intubated patients on microaspiration, ventilator-associated events and clinical outcomes. DESIGN Prospective, two-group, single-blind, randomized clinical trial. METHODS The study was conducted between 2014 - 2017 in 513 participants enroled within 24 hr of intubation and randomized into NO-ASPIRATE or usual care groups. Standard oral care was provided to all participants every 4 hr and deep oropharyngeal suctioning was added to the NO-ASPIRATE group. Oral and tracheal specimens were obtained to quantify α-amylase as an aspiration biomarker. RESULTS Data were analysed for 410 study completers enrolled at least 36 hr: NO-ASPIRATE (N = 206) and usual care (N = 204). Percent of tracheal specimens positive for α-amylase, mean tracheal α-amylase levels over time and ventilator-associated events were not different between groups. The NO-ASPIRATE group had a shorter hospital length of stay and a subgroup with moderate aspiration at baseline had significantly lower α-amylase levels across time. CONCLUSION Hospital length of stay was shorter in the NO-ASPIRATE group and a subgroup of intervention participants had lower α-amylase across time. Delivery of standardized oral care to all participants may have been an intervention itself and possibly associated with the lack of significant findings for most outcomes. IMPACT This trial compared usual care to oral care with a deep suctioning intervention on microaspiration and ventilator-associated events, as this has not been systematically studied. Further research on the usefulness of α-amylase as an aspiration biomarker and the role of oral suctioning, especially for certain populations, is indicated. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT02284178.
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Affiliation(s)
- Mary Lou Sole
- University of Central Florida College of Nursing, Orlando, Florida
- Center for Nursing Research and Advanced Nursing Practice, Orlando Health, Orlando, Florida
| | - Steven Talbert
- University of Central Florida College of Nursing, Orlando, Florida
| | - Xin Yan
- Department of Statistics, University of Central Florida College of Sciences, Orlando, Florida
| | - Daleen Penoyer
- Center for Nursing Research and Advanced Nursing Practice, Orlando Health, Orlando, Florida
| | - Devendra Mehta
- Pediatric Specialty Diagnostic Laboratory, Arnold Palmer Hospital, Orlando Health, Orlando, Florida
| | - Melody Bennett
- Center for Nursing Research and Advanced Nursing Practice, Orlando Health, Orlando, Florida
| | | | - Aurea Middleton
- Center for Nursing Research and Advanced Nursing Practice, Orlando Health, Orlando, Florida
| | - Lara Deaton
- Center for Nursing Research and Advanced Nursing Practice, Orlando Health, Orlando, Florida
| | - Bassam Abomoelak
- Pediatric Specialty Diagnostic Laboratory, Arnold Palmer Hospital, Orlando Health, Orlando, Florida
| | - Chirajyoti Deb
- Pediatric Specialty Diagnostic Laboratory, Arnold Palmer Hospital, Orlando Health, Orlando, Florida
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Sole ML, Talbert S, Yan X, Penoyer D, Mehta D, Bennett M, Middleton A, Emery KP. Nursing oral suction intervention to reduce aspiration and ventilator events (NO-ASPIRATE): A randomized clinical trial. J Adv Nurs 2019; 75:1108-1118. [PMID: 30507045 PMCID: PMC6568323 DOI: 10.1111/jan.13920] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/13/2018] [Accepted: 10/22/2018] [Indexed: 01/04/2023]
Abstract
AIM The primary aim of this study is to compare an oropharyngeal suction intervention versus usual care on microaspiration in intubated patients. Secondary aims are to evaluate the intervention on ventilator-associated condition rates, time to occurrence and compare tracheal-oral α-amylase ratios between groups. DESIGN Prospective randomized clinical trial. METHODS The study received funding from the National Institutes of Health in February 2014 and Institutional Review Board approval in July 2013. Over 4 years, a convenience sample of 600 orally intubated, ventilated adult patients will be enrolled within 24 hr of intubation. The target sample is 400 participants randomized to the two groups. The intervention involves enhanced suctioning of the mouth and oropharynx every 4 hr, while the usual care group receives a sham suctioning. The research team will deliver usual oral care to all patients every 4 hr and collect oral and tracheal specimens every 12 hr, to quantify α-amylase levels to detect aspiration of oral secretions. Study completers must be enrolled at least 36 hr (baseline and three paired samples). Outcomes include α-amylase levels, percent of positive specimens, ventilator-associated conditions, length of stay, ventilator hours, and discharge disposition. DISCUSSION Enrolment has closed, and data analysis has begun. Subgroup analyses emerged, contributing to future research knowledge. IMPACT Standardized interventions have reduced but do not address all risk factors associated with ventilator-associated conditions. This study provides the potential to reduce microaspiration and associated sequelae in critically ill, intubated patients.
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Affiliation(s)
- Mary Lou Sole
- University of Central Florida College of Nursing, Orlando, Florida
- Orlando Health, Orlando, Florida
| | - Steven Talbert
- University of Central Florida College of Nursing, Orlando, Florida
| | - Xin Yan
- University of Central Florida College of Sciences, Orlando, Florida
| | - Daleen Penoyer
- Center for Nursing Research and Advanced Nursing Practice, Orlando Health, Orlando, Florida
| | | | | | | | - Kimberly Paige Emery
- University of Central Florida College of Nursing, Orlando, Florida
- Orlando Health, Orlando, Florida
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Bonell A, Azarrafiy R, Huong VTL, Viet TL, Phu VD, Dat VQ, Wertheim H, van Doorn HR, Lewycka S, Nadjm B. A Systematic Review and Meta-analysis of Ventilator-associated Pneumonia in Adults in Asia: An Analysis of National Income Level on Incidence and Etiology. Clin Infect Dis 2019; 68:511-518. [PMID: 29982303 PMCID: PMC6336913 DOI: 10.1093/cid/ciy543] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/29/2018] [Indexed: 01/31/2023] Open
Abstract
Background Ventilator-associated pneumonia (VAP) is the commonest hospital-acquired infection (HAI) in intensive care. In Asia, VAP is increasingly caused by resistant gram-negative organisms. Despite the global antimicrobial resistance crisis, the epidemiology of VAP is poorly documented in Asia. Methods We systematically reviewed literature published on Ovid Medline, Embase Classic, and Embase from 1 January 1990 to 17 August 2017 to estimate incidence, prevalence, and etiology of VAP. We performed a meta-analysis to give pooled rates and rates by country income level. Results Pooled incidence density of VAP was high in lower- and upper-middle-income countries and lower in high-income countries (18.5, 15.2, and 9.0 per 1000 ventilator-days, respectively). Acinetobacter baumannii (n = 3687 [26%]) and Pseudomonas aeruginosa (n = 3176 [22%]) were leading causes of VAP; Staphylococcus aureus caused 14% (n = 1999). Carbapenem resistance was common (57.1%). Conclusions VAP remains a common cause of HAI, especially in low- and middle-income countries, and antibiotic resistance is high.
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Affiliation(s)
- Ana Bonell
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
| | | | - Vu Thi Lan Huong
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
| | - Thanh Le Viet
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
| | | | | | - Heiman Wertheim
- Department of Medical Microbiology, Radboud Center of Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - H Rogier van Doorn
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
| | - Sonia Lewycka
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
| | - Behzad Nadjm
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
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Atashi V, Yousefi H, Mahjobipoor H, Yazdannik A. The barriers to the prevention of ventilator-associated pneumonia from the perspective of critical care nurses: A qualitative descriptive study. J Clin Nurs 2018; 27:e1161-e1170. [PMID: 29215801 DOI: 10.1111/jocn.14216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2017] [Indexed: 12/29/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to explore the perspectives of Iranian critical care nurses on the barriers to ventilator-associated pneumonia prevention in intensive care units. BACKGROUND Most patients hospitalized in intensive care units need mechanical ventilation. One of the most prevalent and serious complications of mechanical ventilation is ventilator-associated pneumonia. There are different barriers to the prevention of this kind of pneumonia. DESIGN Qualitative descriptive design was used. METHODS In this qualitative study, 23 critical care nurses were recruited via purposive sampling. Semi-structured interviews were done for data collection. The interviews were recorded digitally, transcribed word by word, and analyzed using the inductive content analysis approach. RESULTS The barriers to the prevention of ventilator-associated pneumonia fell into three main categories, namely nurses' limited professional competence, unfavorable environmental conditions, and passive human resource management. The 10 subcategories of these main categories were unfavorable professional attitude, limited professional knowledge, low job motivation, limited professional accountability, non-standard physical structure, inadequate or inappropriate equipment, heavy workload, staff shortage, inadequate staff training, and ineffective supervision. CONCLUSION The barriers to the prevention of ventilator-associated pneumonia in intensive care units are very diverse and complex and include a wide range of interrelated personal, environmental, and organizational barriers. RELEVANCE TO CLINICAL PRACTICE This study created a better understanding of the barriers to ventilator-associated pneumonia prevention. Moreover, highlighted the importance of sufficient resources, adequate staffing level, and contextually-appropriate evidence-based guidelines for effective ventilator-associated pneumonia prevention.
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Affiliation(s)
- Vajihe Atashi
- Student Research Committee, Faculty of Nursing and Midwifery School, Isfahan University of Medical Science, Isfahan, Iran
| | - Hojatollah Yousefi
- Ulcer Repair Research Center, School of Nursing and Midwifery, Isfahan University of Medical Science, Isfahan, Iran
| | - Hosein Mahjobipoor
- Department of Anesthesiology and Critical Care Medicine, Critical care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmadreza Yazdannik
- Critical Care Nursing Department, Nursing and Midwifery School, Nursing and Midwifery Care Research Center, Isfahan University of Medical Science, Isfahan, Iran
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Tabaeian SM, Yazdannik A, Abbasi S. Compliance with the Standards for Prevention of Ventilator-Associated Pneumonia by Nurses in the Intensive Care Units. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2017; 22:31-36. [PMID: 28382055 PMCID: PMC5364749 DOI: 10.4103/1735-9066.202073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Ventilator-associated pneumonia (VAP) is the most common infection in the intensive care unit, and has many side effects such as increased mortality, increased length of hospital stay, and increased health costs. This study aimed to evaluate the compliance with the standards for prevention of VAP by nurses in the intensive care units. MATERIALS AND METHODS In this descriptive cross-sectional study, 120 nurses in 11 intensive care units of hospitals affiliated to Isfahan university of Medical Sciences, Iran, were assessed for 4 months from July to October 2014. The implementation of all measures for the prevention of VAP was investigated through observation and using a checklist. RESULTS The mean compliance with the standards for the prevention of VAP in the intensive care unit by the nurses was 56.32%; analysis of variance test showed significant difference between the hospitals (P < 0.001). Disposable ventilator circuit was performed for all patients; however, reviewing the patient readiness for separation from the ventilator was not conducted on a daily basis. CONCLUSIONS Compliance with the standards for the prevention of VAP in the intensive care units was relatively acceptable; however, it still requires serious attention by the officials with training and sensitization of nurses in implementing preventive measures, especially through the provision of clinical guidelines and related protocols.
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Affiliation(s)
- Saiede Masomeh Tabaeian
- Student Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmadreza Yazdannik
- Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Abbasi
- Department of Anesthesiology and Intensive Care, Isfahan University of Medical Sciences, Isfahan, Iran
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Abbasinia M, Bahrami N, Bakhtiari S, Yazdannik A, Babaii A. The Effect of a Designed Respiratory Care Program on the Incidence of Ventilator-Associated Pneumonia: A Clinical Trial. J Caring Sci 2016; 5:161-7. [PMID: 27354980 PMCID: PMC4923840 DOI: 10.15171/jcs.2016.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/24/2015] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Ventilator-associated pneumonia is a common complication of mechanical ventilation. This study aimed to evaluate the effect of designed respiratory care program on incidence of ventilator-associated pneumonia (VAP) in the mechanically ventilated patient. METHODS In this clinical trial, 64 patients were selected among those who had undergone mechanical ventilation in the ICU of Al‑Zahra Hospital, Isfahan, Iran, using convenience sampling method. The subjects were randomly allocated to intervention and control groups. In the intervention group an upper respiratory care program and in the control group, routine cares were done. Modified Clinical Pulmonary Infection Questionnaire was completed before and on the third, fourth and fifth day of study. Data were analyzed by Chi-square and independent t-test through SPSS Ver.13. RESULTS The results of this study showed that until the third day of study, the incidence of VAP was similar in the both groups. However, on the fifth day of study, the incidence of VAP in the intervention group was significantly lower than control group. CONCLUSION The results of this study showed that an upper respiratory care program reduced the incidence of VAP. Therefore, nurses are recommended to perform this program for prevention of VAP.
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Affiliation(s)
- Mohammad Abbasinia
- Department of Nursing, Faculty of Nursing & Midwifery, Qom University of
Medical Sciences, Qom, Iran
| | - Nasim Bahrami
- Department of Nursing, Faculty of Nursing & Midwifery, Yazd University of
Medical Sciences, Yazd, Iran
| | - Soheila Bakhtiari
- Department of Operating Room Nursing, Faculty of Nursing & Midwifery,
Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmadreza Yazdannik
- Department of Critical Care Nursing, Nursing and Midwifery Care Research Center,
Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan,
Iran
| | - Atye Babaii
- Department of Nursing, Faculty of Nursing & Midwifery, Qom University of
Medical Sciences, Qom, Iran
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Kučan M, Djekić B, Ravljen M. The influence of the endotracheal tube cuff on the occurrence of ventilator-associated pneumonia. OBZORNIK ZDRAVSTVENE NEGE 2015. [DOI: 10.14528/snr.2015.49.3.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: An endotracheal tube enables patient ventilation, but also presents a risk of complications. The accumulation of subglottic secretions above the cuff may cause ventilatorassociated pneumonia. The purpose of the article is to establish the effect of the endotracheal tube cuff (shape and material, method of inflation, verifying and maintaining pressure) on the incidence of ventilator-associated pneumonia.
Methods: A descriptive method with a systematic review of domestic and foreign literature was used. The literature was retrieved from electronic databases and the cooperative bibliographic/catalogue database. According to eligibility criteria, sixteen original scientific articles published in the last ten years were finally used. Data were processed with qualitative content analysis.
Results: Cuff inflation control with a manometer and continuous measuring and adjustment of cuff pressure with modern equipment were found to be the safest methods. According to the articles on shape and material, conical polyurethane cuffs provide the best sealing.
Discussion and conclusion: Ventilator-associated pneumonia is a serious complication in mechanically ventilated patients. Maintaining appropriate cuff pressure proved to be a very effective preventive measure. The research presented here is limited by the small number of available articles. Further research is needed before practical applications are attempted.
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Smith N, Khan F, Gratrix A. A Retrospective Review of Patients Managed with the Pneux PY™ VAP Prevention System. J Intensive Care Soc 2014. [DOI: 10.1177/175114371401500203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Ventilator-associated pneumonia (VAP) is commonplace in intensive care and has implications for patients' morbidity and mortality in hospital. A range of interventions exists to prevent the development of VAP. We reviewed the impact of the PneuX PY™ VAP prevention system on the incidence of VAP and its effects on local practice. In total, 48 patients in a mixed medical and surgical intensive care unit received the PneuX PY VAP prevention system and its associated care package in 2010. The VAP rate for this cohort of patients was found to be 6.25% (n=3) in the local context of historical VAP rates above 26%. Notably, 17% of extubations were unplanned, of which almost two-thirds were self-extubations. The PneuX PY VAP prevention system facilitated lower VAP rates than those documented elsewhere and highlighted the incidence of unplanned extubations in local practice. Further evaluation of the implementation of the PneuX PY VAP prevention system in intensive care areas, in tandem with large-scale evaluation of its effectiveness, are still required.
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Affiliation(s)
- Neil Smith
- Research Nurse, Department of Anaesthesia and Critical Care, Hull Royal Infirmary
| | - Faheem Khan
- Consultant in Intensive Care and Emergency Medicine, Royal Wolverhampton Hospital NHS Trust
| | - Andrew Gratrix
- Consultant in Intensive Care, Department of Anaesthesia and Critical Care, Hull Royal Infirmary
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