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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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Rahimibashar F, Miller AC, Yaghoobi MH, Vahedian-Azimi A. A comparison of diagnostic algorithms and clinical parameters to diagnose ventilator-associated pneumonia: a prospective observational study. BMC Pulm Med 2021; 21:161. [PMID: 33985474 PMCID: PMC8118372 DOI: 10.1186/s12890-021-01527-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 05/06/2021] [Indexed: 12/15/2022] Open
Abstract
Background Suspicion and clinical criteria continue to serve as the foundation for ventilator-associated pneumonia (VAP) diagnosis, however the criteria used to diagnose VAP vary widely. Data from head-to-head comparisons of clinical diagnostic algorithms is lacking, thus a prospective observational study was performed to determine the performance characteristics of the Johanson criteria, Clinical Pulmonary Infection Score (CPIS), and Centers for Disease Control and Prevention’s National Healthcare Safety Network (CDC/NHSN) criteria as compared to Hospital in Europe Link for Infection Control through Surveillance (HELICS) reference standard. Methods A prospective observational cohort study was performed in three mixed medical-surgical ICUs from one academic medical center from 1 October 2016 to 30 April 2018. VAP diagnostic criteria were applied to each patient including CDC/NHSN, CPIS, HELICS and Johanson criteria. Tracheal aspirate cultures (TAC) and serum procalcitonin values were obtained for each patient. Results Eighty-five patients were enrolled (VAP 45, controls 40). Using HELICS as the reference standard, the sensitivity and specificity for each of the assessed diagnostic algorithms were: CDC/NHSN (Sensitivity 54.2%; Specificity 100%), CPIS (Sensitivity 68.75%; Specificity 95.23%), Johanson (Sensitivity 67.69%; Specificity 95%). The positive TAC rate was 81.2%. The sensitivity for positive TAC with the serum procalcitonin level > 0.5 ng/ml was 51.8%. Conclusion VAP remains a considerable source of morbidity and mortality in modern intensive care units. The optimal diagnostic method remains unclear. Using HELICS criteria as the reference standard, CPIS had the greatest comparative diagnostic accuracy, whereas the sensitivity of the CDC/NHSN was only marginally better than a positive TAC plus serum procalcitonin > 0.5 ng/ml. Algorithm accuracy was improved by adding serum procalcitonin > 0.5 ng/ml, but not positive quantitative TAC. Trial Registration: Not indicated for this study type.
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Affiliation(s)
- Farshid Rahimibashar
- Anesthesia and Critical Care Department, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Andrew C Miller
- Department of Emergency Medicine, Nazareth Hospital, Philadelphia, PA, USA
| | - Mojtaba H Yaghoobi
- Department of Infectious and Tropical Diseases, Alborz University of Medical Sciences, Alborz, Iran
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Dantas EMGL, Lima SMF, Cantuária APC, Amorim IA, Almeida JA, Cunha TF, Franco OL, Rezende TMB. Synergistic activity of chlorhexidine and synoeca-MP peptide against Pseudomonas aeruginosa. J Cell Physiol 2019; 234:16068-16079. [PMID: 30740688 DOI: 10.1002/jcp.28265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/16/2019] [Accepted: 01/22/2019] [Indexed: 01/24/2023]
Abstract
This study aims to evaluate the in vitro antimicrobial and immunomodulatory activities and cytotoxicity of chlorhexidine (CHX) and synoeca-MP peptide alone or in combination against Pseudomonas aeruginosa. The antimicrobial property was evaluated by the determination of minimal inhibitory concentration, minimum bactericidal concentration, and planktonic bacteria and biofilm inhibition. Immunomodulatory activity was determined by enzyme-linked immunosorbent assay and nitric oxide production by the Griess reaction method. According to the results, synoeca-MP combined with CHX demonstrated antimicrobial effectiveness compared with its isolated use, in addition to immunomodulatory activity (upregulating MPC-1 and tumor necrosis factor-α and downregulating nitric oxide and interleukin-10). In this context, it is expected that the substances, together, could be capable of controlling bacterial infection and dissemination, besides potentiating macrophages' immune response against the studied microorganism. Moreover, reducing the CHX concentration by the addition of synoeca-MP peptide may, in a beneficial way, minimize the undesirable effects of both, CHX and synoeca-MP in a clinical setting.
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Affiliation(s)
- Elaine M G L Dantas
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, Federal District, Brazil.,Curso de Odontologia, Escola de Saúde, Universidade Católica de Brasília, Campus 1, Brasília, Federal District, Brazil.,Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Escola de Saúde, Universidade Católica de Brasília, Campus Avançado Asa Norte, Brasília, Federal District, Brazil
| | - Stella M F Lima
- Curso de Odontologia, Escola de Saúde, Universidade Católica de Brasília, Campus 1, Brasília, Federal District, Brazil.,Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Escola de Saúde, Universidade Católica de Brasília, Campus Avançado Asa Norte, Brasília, Federal District, Brazil
| | - Ana Paula C Cantuária
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, Federal District, Brazil
| | - Ingrid A Amorim
- Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Escola de Saúde, Universidade Católica de Brasília, Campus Avançado Asa Norte, Brasília, Federal District, Brazil
| | - Jeeser A Almeida
- Programa de Pós-Graduação em Saúde e Desenvolvimento na Região Centro-Oeste, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Tássio F Cunha
- Curso de Odontologia, Escola de Saúde, Universidade Católica de Brasília, Campus 1, Brasília, Federal District, Brazil
| | - Octávio L Franco
- Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Escola de Saúde, Universidade Católica de Brasília, Campus Avançado Asa Norte, Brasília, Federal District, Brazil.,Programa de Doutorado da Rede Centro-Oeste, Universidade de Brasília, Campus Universitário Darcy Ribeiro, Brasília, Federal District, Brazil.,S-Inova Biotech, Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande, Mato Grosso do Sul, Brazil
| | - Taia M B Rezende
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, Federal District, Brazil.,Curso de Odontologia, Escola de Saúde, Universidade Católica de Brasília, Campus 1, Brasília, Federal District, Brazil.,Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Escola de Saúde, Universidade Católica de Brasília, Campus Avançado Asa Norte, Brasília, Federal District, Brazil
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Xu Y, Lai C, Xu G, Meng W, Zhang J, Hou H, Pi H. Risk factors of ventilator-associated pneumonia in elderly patients receiving mechanical ventilation. Clin Interv Aging 2019; 14:1027-1038. [PMID: 31289438 PMCID: PMC6566835 DOI: 10.2147/cia.s197146] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/26/2019] [Indexed: 01/07/2023] Open
Abstract
Purpose: The aim of this study was to verify the potential risk factors of ventilator-associated pneumonia (VAP) in elderly Chinese patients receiving mechanical ventilation (MV). The secondary aim of this study was to present logistical regression prediction models of VAP occurrence in elderly Chinese patients receiving MV. Methods: Patients (aged 80 years or above) receiving MV for ≥48 h were enrolled from the Chinese People's Liberation Army (PLA) General Hospital from January 2011 to December 2015. A chi-squared test and Mann-Whitney U-test were used to compare the data between participants with VAP and without VAP. Univariate logistic regression models were performed to explore the relationship between risk factors and VAP. Results: A total of 901 patients were included in the study, of which 156 were diagnosed as VAP (17.3%). The incidence density of VAP was 4.25/1,000 ventilator days. Logistic regression analysis showed that the independent risk factors for elderly patients with VAP were COPD (OR =1.526, P < 0.05), intensive care unit (ICU) admission (OR=1.947, P < 0.01), the MV methods (P < 0.023), the number of antibiotics administered (OR=4.947, P < 0.01), the number of central venous catheters (OR=1.809, P < 0.05), the duration of indwelling urinary catheter (OR=1.805, P < 0.01) and the use of corticosteroids prior to MV (OR=1.618, P < 0.05). Logistic regression prediction model of VAP occurrence in the Chinese elderly patients with mechanical ventilation:L o g i t P = - 6 . 468 + 0 . 423 X 1 + 0 . 666 X 2 + 0 . 871 X 3 + - 0 . 501 X 5 + 0 . 122 X 6 + 0 . 593 X 7 + 0 . 590 X 8 + 1 . 599 X 9 . Conclusion: VAP occurrence is associated with a variety of controllable factors including the MV methods and the number of antibiotics administered. A model was established to predict VAP occurrence so that high-risk patients could be identified as early as possible.
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Affiliation(s)
- Yue Xu
- Department of Nursing, Chinese People’s Liberation Army (PLA) General Hospital, Chinese PLA Medical Academy, Beijing, People’s Republic of China
| | - Chunyun Lai
- Department of Respiratory, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Guogang Xu
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Wenwen Meng
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Jie Zhang
- Department of Nursing, Chinese People’s Liberation Army (PLA) General Hospital, Chinese PLA Medical Academy, Beijing, People’s Republic of China
| | - Huiru Hou
- Department of Nursing, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Hongying Pi
- Department of Nursing, Chinese People’s Liberation Army (PLA) General Hospital, Chinese PLA Medical Academy, Beijing, People’s Republic of China
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Peña-López Y, Ramirez-Estrada S, Eshwara VK, Rello J. Limiting ventilator-associated complications in ICU intubated subjects: strategies to prevent ventilator-associated events and improve outcomes. Expert Rev Respir Med 2018; 12:1037-1050. [PMID: 30460868 DOI: 10.1080/17476348.2018.1549492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Intubation is required to maintain the airways in comatose patients and enhance oxygenation in hypoxemic or ventilation in hypercapnic subjects. Recently, the Centers of Disease Control (CDC) created new surveillance definitions designed to identify complications associated with poor outcomes. Areas covered: The new framework proposed by CDC, Ventilator-Associated Events (VAE), has a range of definitions encompassing Ventilator-Associated Conditions (VAC), Infection-related Ventilator-Associated Complications (IVAC), or Possible Ventilator-Associated Pneumonia - suggesting replacing the traditional definitions of Ventilator-Associated Tracheobronchitis (VAT) and Ventilator-Associated Pneumonia (VAP). They focused more on oxygenation variations than on Chest-X rays or inflammatory biomarkers. This article will review the spectrum of infectious (VAP & VAT) complications, as well as the main non-infectious complications, namely pulmonary edema, acute respiratory distress syndrome (ARDS) and atelectasis. Strategies to limit these complications and improve outcomes will be presented. Expert commentary: Improving outcomes should be the objective of implementing bundles of prevention, based on risk factors amenable of intervention. Promotion of measures that reduce the exposition or duration of intubation should be a priority.
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Affiliation(s)
- Yolanda Peña-López
- a Pediatric Critical Care Department , Vall d'Hebron Barcelona Hospital Campus , Barcelona , Spain
| | | | - Vandana Kalwaje Eshwara
- c Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education , Manipal University , Manipal , India
| | - Jordi Rello
- d Clinical Research/epidemiology In Pneumonia & Sepsis , Vall d'Hebron Institut of Research & Centro de Investigacion Biomedica en Red (CIBERES) , Barcelona , Spain
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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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Sands KM, Wilson MJ, Lewis MAO, Wise MP, Palmer N, Hayes AJ, Barnes RA, Williams DW. Respiratory pathogen colonization of dental plaque, the lower airways, and endotracheal tube biofilms during mechanical ventilation. J Crit Care 2016; 37:30-37. [PMID: 27621110 DOI: 10.1016/j.jcrc.2016.07.019] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/10/2016] [Accepted: 07/24/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE In mechanically ventilated patients, the endotracheal tube is an essential interface between the patient and ventilator, but inadvertently, it also facilitates the development of ventilator-associated pneumonia (VAP) by subverting pulmonary host defenses. A number of investigations suggest that bacteria colonizing the oral cavity may be important in the etiology of VAP. The present study evaluated microbial changes that occurred in dental plaque and lower airways of 107 critically ill mechanically ventilated patients. MATERIALS AND METHODS Dental plaque and lower airways fluid was collected during the course of mechanical ventilation, with additional samples of dental plaque obtained during the entirety of patients' hospital stay. RESULTS A "microbial shift" occurred in dental plaque, with colonization by potential VAP pathogens, namely, Staphylococcus aureus and Pseudomonas aeruginosa in 35 patients. Post-extubation analyses revealed that 70% and 55% of patients whose dental plaque included S aureus and P aeruginosa, respectively, reverted back to having a predominantly normal oral microbiota. Respiratory pathogens were also isolated from the lower airways and within the endotracheal tube biofilms. CONCLUSIONS To the best of our knowledge, this is the largest study to date exploring oral microbial changes during both mechanical ventilation and after recovery from critical illness. Based on these findings, it was apparent that during mechanical ventilation, dental plaque represents a source of potential VAP pathogens.
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Affiliation(s)
- Kirsty M Sands
- Oral and Biomedical Sciences, School of Dentistry, Cardiff University, Cardiff, Wales, UK.
| | - Melanie J Wilson
- Oral and Biomedical Sciences, School of Dentistry, Cardiff University, Cardiff, Wales, UK
| | - Michael A O Lewis
- Oral and Biomedical Sciences, School of Dentistry, Cardiff University, Cardiff, Wales, UK
| | - Matt P Wise
- Adult Critical Care, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
| | - Nicki Palmer
- Adult Critical Care, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
| | - Anthony J Hayes
- Bioimaging Hub, School of Biosciences, Cardiff University, Cardiff, Wales, UK
| | - Rosemary A Barnes
- Cardiff Institute of Infection & Immunity, School of Medicine, Heath Park, Cardiff, Wales, UK
| | - David W Williams
- Oral and Biomedical Sciences, School of Dentistry, Cardiff University, Cardiff, Wales, UK
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International multidisciplinary consensus conference on multimodality monitoring: ICU processes of care. Neurocrit Care 2015; 21 Suppl 2:S215-28. [PMID: 25208666 DOI: 10.1007/s12028-014-0020-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
There is an increased focus on evaluating processes of care, particularly in the high acuity and cost environment of intensive care. Evaluation of neurocritical-specific care and evidence-based protocol implementation are needed to effectively determine optimal processes of care and effect on patient outcomes. General quality measures to evaluate intensive care unit (ICU) processes of care have been proposed; however, applicability of these measures in neurocritical care populations has not been established. A comprehensive literature search was conducted for English language articles from 1990 to August 2013. A total of 1,061 articles were reviewed, with 145 meeting criteria for inclusion in this review. Care in specialized neurocritical care units or by neurocritical teams can have a positive impact on mortality, length of stay, and in some cases, functional outcome. Similarly, implementation of evidence-based protocol-directed care can enhance outcome in the neurocritical care population. There is significant evidence to support suggested quality indicators for the general ICU population, but limited research regarding specific use in neurocritical care. Quality indices for neurocritical care have been proposed; however, additional research is needed to further validate measures.
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Prevention of ventilator-associated pneumonia and ventilator-associated conditions: a randomized controlled trial with subglottic secretion suctioning. Crit Care Med 2015; 43:22-30. [PMID: 25343570 DOI: 10.1097/ccm.0000000000000674] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Ventilator-associated pneumonia diagnosis remains a debatable topic. New definitions of ventilator-associated conditions involving worsening oxygenation have been recently proposed to make surveillance of events possibly linked to ventilator-associated pneumonia as objective as possible. The objective of the study was to confirm the effect of subglottic secretion suctioning on ventilator-associated pneumonia prevalence and to assess its concomitant impact on ventilator-associated conditions and antibiotic use. DESIGN Randomized controlled clinical trial conducted in five ICUs of the same hospital. PATIENTS Three hundred fifty-two adult patients intubated with a tracheal tube allowing subglottic secretion suctioning were randomly assigned to undergo suctioning (n = 170, group 1) or not (n = 182, group 2). MAIN RESULTS During ventilation, microbiologically confirmed ventilator-associated pneumonia occurred in 15 patients (8.8%) of group 1 and 32 patients (17.6%) of group 2 (p = 0.018). In terms of ventilatory days, ventilator-associated pneumonia rates were 9.6 of 1,000 ventilatory days and 19.8 of 1,000 ventilatory days, respectively (p = 0.0076). Ventilator-associated condition prevalence was 21.8% in group 1 and 22.5% in group 2 (p = 0.84). Among the 47 patients with ventilator-associated pneumonia, 25 (58.2%) experienced a ventilator-associated condition. Neither length of ICU stay nor mortality differed between groups; only ventilator-associated condition was associated with increased mortality. The total number of antibiotic days was 1,696 in group 1, representing 61.6% of the 2,754 ICU days, and 1,965 in group 2, representing 68.5% of the 2,868 ICU days (p < 0.0001). CONCLUSIONS Subglottic secretion suctioning resulted in a significant reduction of ventilator-associated pneumonia prevalence associated with a significant decrease in antibiotic use. By contrast, ventilator-associated condition occurrence did not differ between groups and appeared more related to other medical features than ventilator-associated pneumonia.
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A new definition of ventilator-associated pneumonia: far from perfect, better than before. Ann Am Thorac Soc 2014; 10:644-5. [PMID: 24364767 DOI: 10.1513/annalsats.201310-361ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Walsh TS, Morris AC, Simpson AJ. Ventilator associated pneumonia: can we ensure that a quality indicator does not become a game of chance? Br J Anaesth 2013; 111:333-7. [PMID: 23946358 DOI: 10.1093/bja/aet131] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Lee MS, Walker V, Chen LF, Sexton DJ, Anderson DJ. The epidemiology of ventilator-associated pneumonia in a network of community hospitals: a prospective multicenter study. Infect Control Hosp Epidemiol 2013; 34:657-62. [PMID: 23739068 DOI: 10.1086/670991] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To describe the epidemiology of ventilator-associated pneumonia (VAP) in community hospitals. DESIGN AND SETTING Prospective study in 31 community hospitals from 2007 to 2011. METHODS VAP surveillance was performed by infection preventionists using the National Healthcare Safety Network protocol. VAP incidence was reported as number of events per 1,000 ventilator-days. We categorized hospitals into small (<30,000 patient-days/year), medium (30,000-60,000 patient-days/year), and large (>60,000 patient-days/year) groups and compared VAP incidence by hospital size. RESULTS he median VAP incidence was 1.4 (interquartile range, 0.4-2.4), and ventilator utilization ratio (VUR) was 0.33 (0.25-0.47). VAP incidence was higher in small hospitals (2.1) than medium (0.85) or large (0.69) hospitals ([Formula: see text]) despite a lower VUR in small hospitals (0.29 vs 0.31 vs 0.44, respectively; [Formula: see text]). The median age of 247 VAP cases was 64 (53-73); 136 (55.1%) were female; 142 (57.5%) were Caucasian; 170 (68.8%) were admitted from home. The length of stay and duration of ventilation were 26 (14-42) and 12 (4-21) days, respectively. The pre- and postinfection hospital stays were 8 (3-13) days and 14 (8-30) days, respectively. Data on outcomes were available in 214 cases (86.6%), and 75 (35.0%) cases died during hospitalization. The top 3 pathogens were methicillin-resistant Staphylococcus aureus (MRSA; [Formula: see text], 27.9%), Pseudomonas species ([Formula: see text], 16.3%), and Klebsiella species ([Formula: see text], 13.3%). CONCLUSIONS VAP incidence was inversely associated with size of hospital. VAP in community hospitals was frequently caused by MRSA. Importantly, predictors of VAP incidence in tertiary care hospitals such as VUR may not be predictive in community hospitals with few ventilated patients.
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Affiliation(s)
- Mi Suk Lee
- Duke Infection Control Outreach Network, Division of Infectious Diseases, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA
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