1
|
Howroyd F, Chacko C, MacDuff A, Gautam N, Pouchet B, Tunnicliffe B, Weblin J, Gao-Smith F, Ahmed Z, Duggal NA, Veenith T. Ventilator-associated pneumonia: pathobiological heterogeneity and diagnostic challenges. Nat Commun 2024; 15:6447. [PMID: 39085269 PMCID: PMC11291905 DOI: 10.1038/s41467-024-50805-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
Ventilator-associated pneumonia (VAP) affects up to 20% of critically ill patients and induces significant antibiotic prescription pressure, accounting for half of all antibiotic use in the ICU. VAP significantly increases hospital length of stay and healthcare costs yet is also associated with long-term morbidity and mortality. The diagnosis of VAP continues to present challenges and pitfalls for the currently available clinical, radiological and microbiological diagnostic armamentarium. Biomarkers and artificial intelligence offer an innovative potential direction for ongoing future research. In this Review, we summarise the pathobiological heterogeneity and diagnostic challenges associated with VAP.
Collapse
Affiliation(s)
- Fiona Howroyd
- Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK.
- Institute of Inflammation and Ageing, The University of Birmingham, Edgbaston, Birmingham, UK.
| | - Cyril Chacko
- Department of Critical Care Medicine and Anaesthesia, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
- Institute of Acute Care, Royal Wolverhampton Hospital and University of Wolverhampton, Wolverhampton, UK
| | - Andrew MacDuff
- Department of Critical Care Medicine and Anaesthesia, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
- Institute of Acute Care, Royal Wolverhampton Hospital and University of Wolverhampton, Wolverhampton, UK
| | - Nandan Gautam
- Critical Care Department, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK
| | - Brian Pouchet
- Critical Care Department, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK
| | - Bill Tunnicliffe
- Critical Care Department, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK
| | - Jonathan Weblin
- Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK
| | - Fang Gao-Smith
- Institute of Inflammation and Ageing, The University of Birmingham, Edgbaston, Birmingham, UK
| | - Zubair Ahmed
- Institute of Inflammation and Ageing, The University of Birmingham, Edgbaston, Birmingham, UK.
| | - Niharika A Duggal
- Institute of Inflammation and Ageing, The University of Birmingham, Edgbaston, Birmingham, UK.
| | - Tonny Veenith
- Department of Critical Care Medicine and Anaesthesia, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.
- Institute of Acute Care, Royal Wolverhampton Hospital and University of Wolverhampton, Wolverhampton, UK.
| |
Collapse
|
2
|
Hassan A, Takacs S, Orde S, Alison JA, Huang S, Milross MA. Clinical application of intrapulmonary percussive ventilation: A scoping review. Hong Kong Physiother J 2024; 44:39-56. [PMID: 38577395 PMCID: PMC10988273 DOI: 10.1142/s1013702524500033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/23/2023] [Indexed: 04/06/2024] Open
Abstract
Impaired respiratory function secondary to acute or chronic respiratory disease poses a significant clinical and healthcare burden. Intrapulmonary percussive ventilation (IPV) is used in various clinical settings to treat excessive airway secretions, pulmonary atelectasis, and impaired gas exchange. Despite IPV's wide use, there is a lack of clinical guidance on IPV application which may lead to inconsistency in clinical practice. This scoping review aimed to summarise the clinical application methods and dosage of IPV used by clinicians and researchers to provide guidance. A two-staged systematic search was conducted to retrieve studies that used IPV in inpatient and outpatient settings. MEDLINE, EMBASE, CINAHL, Scopus, and Google scholar were searched from January 1979 till 2022. Studies with patients aged ≥16 years and published in any language were included. Two reviewers independently screened the title and abstract, reviewed full text articles, and extracted data. Search yielded 514 studies. After removing duplicates and irrelevant studies, 25 studies with 905 participants met the inclusion criteria. This is the first scoping review to summarise IPV application methods and dosages from the available studies in intensive care unit (ICU), acute inpatient (non-ICU), and outpatient settings. Some variations in clinical applications and prescribed dosages of IPV were noted. Despite variations, common trends in clinical application and prescription of IPV dosages were observed and summarised to assist clinicians with IPV intervention. Although an evidence-based clinical guideline could not be provided, this review provides detailed information on IPV application and dosages in order to provide clinical guidance and lays a foundation towards developing a clinical practice guideline in the future.
Collapse
Affiliation(s)
- Anwar Hassan
- Physiotherapy Department, Nepean Hospital, Nepean Blue Mountains Local Health District Kingswood, NSW, Australia
- Intensive Care Unit, Nepean Hospital, Nepean Blue Mountains Local Health District Kingswood, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Sidney Takacs
- Physiotherapy Department, Nepean Hospital, Nepean Blue Mountains Local Health District Kingswood, NSW, Australia
| | - Sam Orde
- Intensive Care Unit, Nepean Hospital, Nepean Blue Mountains Local Health District Kingswood, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Jennifer A Alison
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Allied Health, Sydney Local Health District, Sydney, NSW, Australia
| | - Stephen Huang
- Intensive Care Unit, Nepean Hospital, Nepean Blue Mountains Local Health District Kingswood, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Maree A Milross
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| |
Collapse
|
3
|
Singh C, Abdullah R. Impact of Ventilator-Associated Pneumonia Preventative Measures and Ventilator Bundle Care in a Tertiary Care Hospital's Adult Intensive Care Unit. Cureus 2024; 16:e59877. [PMID: 38854202 PMCID: PMC11157479 DOI: 10.7759/cureus.59877] [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] [Received: 12/22/2023] [Accepted: 05/07/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND The mitigation of ventilator-associated pneumonia (VAP) is a vital undertaking in safeguarding patient well-being. The research aimed to evaluate the impact of a multidisciplinary, comprehensive monitoring approach on VAP incidence in a tertiary medical-surgical-trauma critical care unit. METHODOLOGY The research was conducted within an adult medical-surgical ICU from June 2021 to December 2022. VAP data were collected by prospective targeted surveillance in accordance with the guidelines provided by the National Healthcare Safety Network (NHSN) and the Centers for Disease Control and Prevention. In contrast, a cross-sectional design was used to gather bundle data, according to the defined methodology of the Institute for Healthcare Improvement (IHI), and the rate of variation in admission prior to the bundle's installation was evaluated. RESULT The features of ventilated patients in adult medical-surgical ICUs were studied between 2021 and 2022. Regarding demographics, men comprised 42.6% and 45.3% of VAP patients and 65.3% and 50.7% of bundle care patients, respectively. Notably, 33.1% of patients in VAP and 54.5% in bundle care were over 60 years old. Clinical indicators such as median age (12.6 vs. 8 months for non-VAP vs. VAP patients), antibiotic usage (65% vs. 99% for non-VAP vs. VAP patients), and risk factors like trauma diagnosis (HR: 2.59, 95% CI: 2.07-3.23), and accidental extubation (HR: 4.11, 95% CI: 1.93-8.73) differed significantly between the bundle and non-bundle care groups. A significant increase in bundle compliance was seen from 90% in 2021 to 97% in 2022 (P-value <0.001), which helped to lower VAP rates and highlight the need for ongoing quality improvement in ICU treatment. CONCLUSION The use of ventilator bundles at a tertiary care hospital resulted in improvements in ventilator utilization, with an approximate increase of 20% and VAP rates of over 70% for adult critical patients.
Collapse
Affiliation(s)
- Chandni Singh
- Department of Cardiac Anaesthesia, Laxmipat Singhania Institute of Cardiology, Kanpur, IND
| | - Rashid Abdullah
- Department of Anaesthesiology and Critical Care, Chandni Hospital, Kanpur, IND
| |
Collapse
|
4
|
Gan W, Chen Z, Tao Z, Li W. Constructing a Nomogram Model to Estimate the Risk of Ventilator-Associated Pneumonia for Elderly Patients in the Intensive Care Unit. Adv Respir Med 2024; 92:77-88. [PMID: 38392034 PMCID: PMC10885902 DOI: 10.3390/arm92010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) causes heavy losses in terms of finances, hospitalization, and death for elderly patients in the intensive care unit (ICU); however, the risk is difficult to evaluate due to a lack of reliable assessment tools. We aimed to create and validate a nomogram to estimate VAP risk to provide early intervention for high-risk patients. METHODS Between January 2016 and March 2021, 293 patients from a tertiary hospital in China were retrospectively reviewed as a training set. Another 84 patients were enrolled for model validation from April 2021 to February 2022. Least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression analysis were employed to select predictors, and a nomogram model was constructed. The calibration, discrimination, and clinical utility of the nomogram were verified. Finally, a web-based online scoring system was created to make the model more practical. RESULTS The predictors were hypoproteinemia, long-term combined antibiotic use, intubation time, length of mechanical ventilation, and tracheotomy/intubation. The area under the curve (AUC) was 0.937 and 0.925 in the training and validation dataset, respectively, suggesting the model exhibited effective discrimination. The calibration curve demonstrated high consistency with the observed result and the estimated values. Decision curve analysis (DCA) demonstrated that the nomogram was clinically applicable. CONCLUSIONS We have created a novel nomogram model that can be utilized to anticipate VAP risk in elderly ICU patients, which is helpful for healthcare professionals to detect patients at high risk early and adopt protective interventions.
Collapse
Affiliation(s)
- Wensi Gan
- Department of Infection Control, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou 325001, China
- Department of Big Data in Health Science, School of Public Health, Zhejiang University, and Center for Clinical Big Data and Statistics, The Second Hospital Affiliated to Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Zhihui Chen
- School of Public Health, Zhejiang University, Hangzhou 310058, China
| | - Zhen Tao
- Department of Intensive Care Unit, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou 325001, China
| | - Wenyuan Li
- Department of Big Data in Health Science, School of Public Health, Zhejiang University, and Center for Clinical Big Data and Statistics, The Second Hospital Affiliated to Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310058, China
| |
Collapse
|
5
|
Thapa D, Chair SY, Chong MS, Poudel RR, Melesse TG, Choi KC, Tam HL. Effects of ventilatory bundles on patient outcomes among ICU patients: A systematic review and meta-analysis. Heart Lung 2024; 63:98-107. [PMID: 37839229 DOI: 10.1016/j.hrtlng.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Ventilator bundles are suggested to prevent ventilator-associated pneumonia (VAP), but significant variations in the effects of the bundle on patient outcomes have been reported. OBJECTIVES To synthesize the evidence and evaluate the effects of the ventilator bundle on patient outcomes among critically ill adult patients. METHODS A broad search was performed in seven databases for relevant articles published from January 2002 to November 2022. Randomized controlled trials and quasi-experimental studies investigating the effects of implementing ventilator bundles in adult intensive care units (ICUs) were included. Two independent reviewers performed the study selection, data extraction, and risk of bias assessment. All data for meta-analysis were pooled using the random-effects model. RESULTS After screening, 19 studies were included in the meta-analysis. Evidence of low-to-moderate certainty showed that the ventilator bundle reduced the rate of VAP (risk ratio [RR] = 0.64; P = 0.003), length of ICU stay (mean difference [MD] = -2.57; P = 0.03), mechanical ventilation days (MD = -3.38; P < 0.001), and ICU mortality (RR = 0.76; P = 0.02). Ventilator bundle was associated with improved outcomes, except mortality. CONCLUSIONS The ventilator bundle, especially the IHI ventilator bundle, was effective in decreasing the incidence of VAP and improving most of the VAP-related outcomes. However, given the low-to-moderate certainty of evidence and high heterogeneity, these results should be interpreted with caution. A future study that adopts hybrid implementation trials with high methodological quality is needed to confirm the effects of the ventilator bundle on patient outcomes.
Collapse
Affiliation(s)
- Dejina Thapa
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Room 704B, 7/F Esther Lee Building, Hong Kong SAR, PR China
| | - Sek Ying Chair
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Room 704B, 7/F Esther Lee Building, Hong Kong SAR, PR China
| | - Mei Sin Chong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Room 704B, 7/F Esther Lee Building, Hong Kong SAR, PR China
| | - Rishi Ram Poudel
- Department of Orthopedics, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Tenaw Gualu Melesse
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Room 704B, 7/F Esther Lee Building, Hong Kong SAR, PR China
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Room 704B, 7/F Esther Lee Building, Hong Kong SAR, PR China
| | - Hon Lon Tam
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Room 704B, 7/F Esther Lee Building, Hong Kong SAR, PR China.
| |
Collapse
|
6
|
Giberson CE, Cheshier SH, Poree LR, Saulino MF. Diaphragm Pacing: A Safety, Appropriateness, Financial Neutrality, and Efficacy Analysis of Treating Chronic Respiratory Insufficiency. Neuromodulation 2023; 26:490-497. [PMID: 36609087 DOI: 10.1016/j.neurom.2022.10.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 10/19/2022] [Accepted: 10/31/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES This study aimed to evaluate the safety and applicability of treating chronic respiratory insufficiency with diaphragm pacing relative to mechanical ventilation. MATERIALS AND METHODS A literature review and analysis were conducted using the safety, appropriateness, financial neutrality, and efficacy principles. RESULTS Although mechanical ventilation is clearly indicated in acute respiratory failure, diaphragm pacing improves life expectancy, increases quality of life, and reduces complications in patients with chronic respiratory insufficiency. CONCLUSION Diaphragm pacing should be given more consideration in appropriately selected patients with chronic respiratory insufficiency.
Collapse
|
7
|
Garegnani LI, Giménez ML, Escobar Liquitay CM, Franco JVA. Oral hygiene interventions to prevent ventilator‐associated pneumonia: A network meta‐analysis. Nurs Crit Care 2022. [DOI: 10.1111/nicc.12865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
8
|
KIŞLAK DEMİRCAN S, NAZİK S, GÜLER S, CİNGÖZ E. Ventilatör İlişkili Pnömonili Hastaların Retrospektif Olarak Değerlendirilmesi: Altı Yıllık Veri. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2022. [DOI: 10.17517/ksutfd.1172690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Amaç: Bu çalışmada yoğun bakım ünitesinde takip edilen ventilatör ilişkili pnömoni (VİP) olgularının demografik özelliklerinin, VİP etkenlerinin ve prognozunun değerlendirilmesi ve bu özelliklerin mortalite ile olan ilişkisinin ortaya konulması amaçlanmıştır.
Gereç ve Yöntem: Çalışma retrospektif ve tek merkezli olarak Ocak 2012-Aralık 2017 tarihleri arasında yapılmıştır. Hastanemizde VİP tanısı ile yatan ≥18 yaş hastalar ve 48 saatten uzun süre mekanik ventilasyon altında olan 533 hasta çalışmaya dahil edilmiştir. Veriler, hastane veri sistemi ve hasta dosyaları incelenerek değerlendirildi. Hastalara ait yaş, cinsiyet, yattığı klinik, kültür antibiyogram sonuçları, komorbidite durumu, hastanede kalış süresi ve hastanın son durumu (taburcu/eksitus) gibi veriler kaydedildi.
Bulgular: Çalışmaya dahil edilen olguların 337’si (%63.2) erkek, 196’sı (%36.8) kadın cinsiyette olup yaş ortalaması 63.8±20.4 yıldı. Hastaların %93.1’inde Gram negatif bakteri, %6.4’ünde Gram pozitif bakteri ve %0.6’sında mantar üremesi saptandı. En sık saptanan etkenler Acinetobacter baumannii (%42.2), Pseudomonas aeruginosa (%19.3), Klebsiella pneumoniae (%12.2) idi. VİP olgularının % 66.2’si mortalite ile sonuçlandı. Prognozu etkileyen risk faktörleri ve eşlik eden hastalıklardan; serebrovasküler hastalıklar, koroner arter hastalığı, malignite, bilinç kapalılığı, peptik ülser profilaksisi, hemodiyalize girme, immünsupresyon varlığı, kardiyopulmoner resusitasyon ve santral venöz kateter varlığının (sırasıyla OR:1.20, 0.38, 0.15, 0.96, 0.76, 0.25, 1.67, 0.19, 0.62) mortaliteyi arttırdığı saptanmıştır. Hastaların tanı anındaki C-reaktif protein (AUC:0.588 p=0,001), prokalsitonin (AUC:0.658 p
Collapse
|
9
|
Belay CM, Zewale TA, Amlak BT, Abebe TG, Hailu G. Incidence and Predictors of Ventilator-Associated Pneumonia Among Adult Intubated Patients in Bahir Dar Specialized Hospitals, 2021: A Retrospective Follow-Up Study. Int J Gen Med 2022; 15:8173-8182. [PMID: 36389019 PMCID: PMC9664917 DOI: 10.2147/ijgm.s380301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/19/2022] [Indexed: 08/30/2023] Open
Abstract
INTRODUCTION Ventilator-associated pneumonia refers to pneumonia that happens at least 48 hours after endotracheal intubation. It is associated with high economic costs, longer attributable lengths of stay in the hospital, and high mortality. Therefore, this study aims to determine the incidence and predictors of ventilator-associated pneumonia among adult intensive care unit admitted patients at Bahir Dar Specialized Hospitals. METHODS A retrospective follow-up study was conducted among 312 adult intensive care unit admitted patients. A data extraction checklist was used to collect the data. The collected data were coded, cleaned, and entered into EpiData version 3.1 and exported to SPSS version 22 and STATA version 14 for analysis. Descriptive analysis was done by using tables, text and percentages. Bivariable and multivariable log binomial analyses were conducted to identify predictors of ventilator-associated pneumonia. Variables having p-value <0.05 were considered statistically significant. RESULTS The study found that 27.9% (95% CI: 23%-33%) of patients developed ventilator-associated pneumonia and the incidence rate of VAP was 45.7 per 1000 ventilator days. Patient's stay more than or equal to 14 days (ARR: 13, 95% CI: 9.3-31) and 7-13 days on MV (ARR: 7.2, 95% CI: 6.2-11), blood transfusion (ARR: 2.8, 95% CI: 1.1-6.9), low GCS (ARR: 2.5, 95% CI: 1.3-5.1), use of corticosteroid (ARR: 2.1, 95% CI: 1.1-4.1), and supine head position (ARR: 8.1, 95% CI: 1.7-40) were identified as independent predictors of ventilator associated pneumonia. CONCLUSION Nearly one-fourth of the participants developed ventilator-associated pneumonia. Duration of ventilation, blood transfusion, corticosteroid use, supine head position, and low Glasgow coma scale were significant predictors of ventilator-associated pneumonia.
Collapse
Affiliation(s)
- Chernet Manaye Belay
- Department of Nursing, Tibebe Ghion Specialized Hospital, Bahir Dar University, Bahir Dar, Ethiopia
| | - Taye Abuhay Zewale
- Department of Epidemiology and Biostatistics, Bahir Dar University, Bahir Dar, Ethiopia
| | | | | | - Getachew Hailu
- Department of Epidemiology and Biostatistics, Bahir Dar University, Bahir Dar, Ethiopia
| |
Collapse
|
10
|
Saito S, Thao PTN, Ishikane M, Xuan PT, Kutsuna S, Dai HQ, Ohtsu H, Kimura T, Kiyohara H, Shimada Y, Maruoka Y, Thuy PTP, Phu TT, Phuong HK, Tra TT, Duy NLM, Ohara H, Kurosu H, Son NT, Ohmagari N. Physical oral care prevents ventilator-associated pneumonia in Vietnam: A prospective interventional study. J Infect Chemother 2022; 28:1632-1638. [PMID: 36049613 DOI: 10.1016/j.jiac.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/14/2022] [Accepted: 08/20/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) has emerged as a critical issue in the intensive care unit (ICU) because of its high burden on patients and medical staff. Here, we examined the potential for reducing VAP incidence through physical oral care interventions without any medication. METHODS This prospective interventional study compared VAP incidence during an 8-month baseline period (usual oral care) and a 9-month intervention period (physical oral care with sponge brush) among patients who received mechanical ventilation for >48 h in a tertiary care hospital in Vietnam from 2017 to 2019. Physical oral care was provided by general ICU nurses who had been trained by dentists and infection control nurses. VAP was diagnosed using the Clinical Pulmonary Infection Score. RESULTS In total, 423 patients were enrolled in the baseline group and 454 patients were enrolled in the intervention group; 303 and 300 patients, respectively, were included in the analysis. Two hundred thirty-eight VAP episodes were identified: 135 (44.6%) during the baseline period and 103 (34.3%) during the intervention period. Univariate analysis revealed significant reduction of VAP occurrence in the intervention period (odds ratio = 0.65; 95% confidence interval = 0.47-0.90; P = 0.010). The incidences of VAP per 1000 ventilator-days were 63.4 (135/2128) during the baseline period and 48.4 (103/2128) during the intervention period (P = 0.038). CONCLUSIONS Physical oral care without any medication (e.g., chlorhexidine) reduced VAP incidence in the ICU. This method could be used to reduce VAP incidence, particularly in countries with limited medical resources.
Collapse
Affiliation(s)
- Sho Saito
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Pham Thi Ngoc Thao
- General Intensive Care Unit, Cho Ray Hospital, Ho Chi Minh City, Viet Nam; Department of Critical Care, Emergency Medicine and Clinical Toxicology, University of Medicine and Pharmacy Ho Chi Minh City, Viet Nam
| | - Masahiro Ishikane
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; Ministry of Health, Viet Nam.
| | - Phan Thi Xuan
- General Intensive Care Unit, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Huynh Quang Dai
- General Intensive Care Unit, Cho Ray Hospital, Ho Chi Minh City, Viet Nam; Department of Critical Care, Emergency Medicine and Clinical Toxicology, University of Medicine and Pharmacy Ho Chi Minh City, Viet Nam
| | - Hiroshi Ohtsu
- Joint Center for Researchers, Associates and Clinicians Data Center, Department of Data Science, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tomomi Kimura
- Oral and Maxillofacial Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroyuki Kiyohara
- Oral and Maxillofacial Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasuyuki Shimada
- Oral and Maxillofacial Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yutaka Maruoka
- Oral and Maxillofacial Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | | | | | | | - Ton Thanh Tra
- Quality Control Management, Cho Ray Hospital, Viet Nam
| | - Nguyen Ly Minh Duy
- Department of Critical Care, Emergency Medicine and Clinical Toxicology, University of Medicine and Pharmacy Ho Chi Minh City, Viet Nam
| | - Hiroshi Ohara
- , JICA Project for Improvement of Hospital Management Competency, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Hitomi Kurosu
- JICA Expert, JICA Project for Improvement of Hospital Management Competency at Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Nguyen Truong Son
- Cho Ray Hospital, Ho Chi Minh City, Viet Nam; Ministry of Health, Viet Nam
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| |
Collapse
|
11
|
Liang Y, Zhu C, Tian C, Lin Q, Li Z, Li Z, Ni D, Ma X. Early prediction of ventilator-associated pneumonia in critical care patients: a machine learning model. BMC Pulm Med 2022; 22:250. [PMID: 35752818 PMCID: PMC9233772 DOI: 10.1186/s12890-022-02031-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/09/2022] [Indexed: 11/26/2022] Open
Abstract
Background This study was performed to develop and validate machine learning models for early detection of ventilator-associated pneumonia (VAP) 24 h before diagnosis, so that VAP patients can receive early intervention and reduce the occurrence of complications. Patients and methods This study was based on the MIMIC-III dataset, which was a retrospective cohort. The random forest algorithm was applied to construct a base classifier, and the area under the receiver operating characteristic curve (AUC), sensitivity and specificity of the prediction model were evaluated. Furthermore, We also compare the performance of Clinical Pulmonary Infection Score (CPIS)-based model (threshold value ≥ 3) using the same training and test data sets. Results In total, 38,515 ventilation sessions occurred in 61,532 ICU admissions. VAP occurred in 212 of these sessions. We incorporated 42 VAP risk factors at admission and routinely measured the vital characteristics and laboratory results. Five-fold cross-validation was performed to evaluate the model performance, and the model achieved an AUC of 84% in the validation, 74% sensitivity and 71% specificity 24 h after intubation. The AUC of our VAP machine learning model is nearly 25% higher than the CPIS model, and the sensitivity and specificity were also improved by almost 14% and 15%, respectively. Conclusions We developed and internally validated an automated model for VAP prediction using the MIMIC-III cohort. The VAP prediction model achieved high performance based on its AUC, sensitivity and specificity, and its performance was superior to that of the CPIS model. External validation and prospective interventional or outcome studies using this prediction model are envisioned as future work. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02031-w.
Collapse
Affiliation(s)
- Yingjian Liang
- Department of Critical Care Medicine, The First Hospital of China Medical University, North Nanjing Street 155, Shenyang, 110001, Liaoning Province, China
| | - Chengrui Zhu
- Department of Critical Care Medicine, The First Hospital of China Medical University, North Nanjing Street 155, Shenyang, 110001, Liaoning Province, China
| | - Cong Tian
- Philips Research China, 5F Building A2, 718 Ling Shi Road, Jing An District, Shanghai, 200072, China
| | - Qizhong Lin
- Philips Research China, 5F Building A2, 718 Ling Shi Road, Jing An District, Shanghai, 200072, China
| | - Zhiliang Li
- Department of Critical Care Medicine, The First Hospital of China Medical University, North Nanjing Street 155, Shenyang, 110001, Liaoning Province, China
| | - Zhifei Li
- Department of Critical Care Medicine, The First Hospital of China Medical University, North Nanjing Street 155, Shenyang, 110001, Liaoning Province, China
| | - Dongshu Ni
- Department of Critical Care Medicine, The First Hospital of China Medical University, North Nanjing Street 155, Shenyang, 110001, Liaoning Province, China
| | - Xiaochun Ma
- Department of Critical Care Medicine, The First Hospital of China Medical University, North Nanjing Street 155, Shenyang, 110001, Liaoning Province, China.
| |
Collapse
|
12
|
Getahun AB, Belsti Y, Getnet M, Bitew DA, Gela YY, Belay DG, Terefe B, Akalu Y, Diress M. Knowledge of intensive care nurses' towards prevention of ventilator-associated pneumonia in North West Ethiopia referral hospitals, 2021: A multicenter, cross-sectional study. Ann Med Surg (Lond) 2022; 78:103895. [PMID: 35734742 PMCID: PMC9207106 DOI: 10.1016/j.amsu.2022.103895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/23/2022] [Accepted: 05/29/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Ventilator-associated pneumonia is a common nosocomial infection that occurs in critically ill patients who are on intubation and mechanical ventilation. Nurses' lack of knowledge may be a barrier to adherence to evidence-based guidelines for preventing ventilator-associated pneumonia. This study aimed to assess the knowledge of intensive care nurses' towards the prevention of ventilator-associated pneumonia. Methods A multicenter cross-sectional study was conducted among nurses working in the intensive care unit from April to July 2021. A pre-tested and structured questionnaire was used to collect data. All intensive care nurses working in the study area were included in the study. Data was entered into Epi-data 4.1 version (EpiData Association, Denmark) and transferred to STATA version 14 (College Station, Texas 77845-4512 USA) statistical software for analysis. Both bi-variable and multivariable binary logistic regression analysis was used to identify factors associated with knowledge of intensive care unit nurse. Variables with a p-value less than <0.2 in the bi-variable analysis were fitted into the multivariable logistic regression analysis. Both Crude and Adjusted Odds Ratio with the corresponding 95% Confidence Interval was calculated to show the strength of association. In multivariable analysis, variables with a p-value of <0.05 were considered statistically significant. Result A total of 213 intensive care nurses were included in the study, with a response rate of 204(95.77%). The mean knowledge score of intensive care nurses regarding the prevention of ventilator-associated pneumonia out of 20 questions is (10.1 ± 2.41). There are 98 (48.04%) of the participants have been found to have good knowledge and 106 (51.96%) of them are rendered poor knowledge about the overall knowledge related to the prevention of ventilator-associated pneumonia. Higher academic qualifications and taking intensive care unit training were significantly associated with good knowledge of ventilator-associated pneumonia prevention in multi-variable logistic regression. Conclusion Our study indicates that the knowledge of intensive care nurses about ventilator-associated pneumonia prevention is not sufficient. Higher academic qualifications and taking intensive care unit training are significantly associated with a good level of knowledge. Therefore it shows the necessity for thorough training and education.
Collapse
Affiliation(s)
- Amare Belete Getahun
- Department of Anesthesia, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yitayeh Belsti
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mihret Getnet
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Desalegn Animut Bitew
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yibeltal Yismaw Gela
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bewuketu Terefe
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yonas Akalu
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mengstie Diress
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
13
|
Fadda RA, Ahmad M. Investigating patient outcomes and healthcare costs associated with ventilator-associated pneumonia. Nurs Manag (Harrow) 2022; 29:32-40. [PMID: 34697933 DOI: 10.7748/nm.2021.e1986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Ventilator-associated pneumonia is the most frequent infection seen in intensive care units. Of those patients with an endotracheal tube, many will develop ventilator-associated pneumonia within 48 hours of being mechanically ventilated. There are many issues related to mechanical ventilation including costs, patient outcomes and the amount of suffering patients experience during the process. AIM To determine the relationship between development of ventilator-associated pneumonia and patient outcomes and costs, including length of stay on mechanical ventilation, in intensive care units (ICU) and in hospital, and mortality rates and to compare results between ventilator-associated pneumonia and non-ventilator-associated pneumonia groups. METHOD Cross-sectional, observational design. A convenience sample of 151 patients on mechanical ventilation (101 with ventilator-associated pneumonia and 50 with non-ventilator-associated pneumonia) were recruited from ICUs in two public hospitals in Jordan. APACHE-II scores, SOFA scores and clinical pulmonary infection scores (CPIS) were assessed. RESULTS The incidence rate of ventilator-associated pneumonia was 50.9/1000 mechanical ventilation days and the cumulative incidence rate was 66.9% among patients on mechanical ventilation. The mean score of hospital length of stay and CPIS was significantly higher in the ventilator-associated pneumonia than the non-ventilator-associated pneumonia group. Higher disease severity and higher organ failure scores increase the risk of mortality in patients with ventilator-associated pneumonia. CONCLUSION A high ventilator-associated pneumonia incidence rate is associated with increased mechanical ventilation, ICU and hospital length of stays, higher mortality and attributed costs. There is a need for continuing education and training for ICU staff to reduce ventilator-associated pneumonia incidence in ICUs.
Collapse
Affiliation(s)
| | - Muayyad Ahmad
- School of Nursing, clinical nursing, The University of Jordan, Amman, Jordan
| |
Collapse
|
14
|
Cagle LA, Hopper K, Epstein SE. Complications associated with long-term positive-pressure ventilation in dogs and cats: 67 cases. J Vet Emerg Crit Care (San Antonio) 2022; 32:376-385. [PMID: 35001482 DOI: 10.1111/vec.13177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/04/2020] [Accepted: 12/16/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the complications associated with positive-pressure ventilation (PPV) in dogs and cats. DESIGN Retrospective study from October 2009 to September 2013. SETTING University Teaching Hospital. ANIMALS Fifty-eight dogs and 9 cats. MEASUREMENTS AND MAIN RESULTS Medical records were retrospectively reviewed; signalment, complications associated with PPV, duration of PPV, and outcome were recorded. Complications most commonly recorded during PPV included hypothermia 41/67 (61%), hypotension 39/67 (58%), cardiac arrhythmias 33/67 (49%), a positive fluid balance 31/67 (46%), oral lesions 25/67 (37%), and corneal ulcerations 24/67 (36%). A definition of ventilator-associated events (VAE) extrapolated from the Center of Disease Control's criteria was applied to 21 cases that received PPV for at least 4 days in this study. Ventilator-associated conditions occurred in 5 of 21 (24%) of cases with infection-related ventilator-associated conditions and ventilator-associated pneumonia identified in 3 of 21 (14%) cases. CONCLUSIONS Complications are common and diverse in dogs and cats receiving long-term PPV and emphasizes the importance of intensive, continuous patient monitoring and appropriate nursing care protocols. Many of the complications identified could be serious without intervention and suggests that appropriate equipment alarms could improve patient safety. Development of veterinary specific surveillance tools such as the VAE criteria would aid future investigations and allow for effective multicenter studies.
Collapse
Affiliation(s)
- Laura A Cagle
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California Davis, Davis, California, USA
| | - Kate Hopper
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, California, USA
| | - Steven E Epstein
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, California, USA
| |
Collapse
|
15
|
Ścisło L, Walewska E, Bodys-Cupak I, Gniadek A, Kózka M. Nutritional Status Disorders and Selected Risk Factors of Ventilator-Associated Pneumonia (VAP) in Patients Treated in the Intensive Care Ward-A Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010602. [PMID: 35010870 PMCID: PMC8744923 DOI: 10.3390/ijerph19010602] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/31/2021] [Accepted: 01/03/2022] [Indexed: 12/11/2022]
Abstract
Introduction: The development of pneumonia in patients treated in intensive care wards is influenced by numerous factors resulting from the primary health condition and co-morbidities. The aim of this study is the determination of the correlation between nutritional status disorders and selected risk factors (type of injury, epidemiological factors, mortality risk, inflammation parameters, age, and gender) and the time of pneumonia occurrence in patients mechanically ventilated in intensive care wards. Material and method: The study included 121 patients with injuries treated in the intensive care ward who had been diagnosed with pneumonia related to mechanical ventilation. The data were collected using the method of retrospective analysis of patients’ medical records available in the electronic system. Results: Ventilator-associated pneumonia (VAP) occurred more frequently in patients over 61 years of age (40.4%), men (67.8%), after multiple-organ injury (45.5%), and those with a lower albumin level (86%), higher CRP values (83.5%), and leukocytes (68.6%). The risk of under-nutrition assessed with the NRS-2002 system was confirmed in the whole study group. The statistical analysis demonstrated a correlation between the leukocytes level (p = 0.012) and epidemiological factors (p = 0.035) and the VAP contraction time. Patients infected with Staphylococcus aureus had 4% of odds for the development of late VAP in comparison to Acinetobacter baumannii (p < 0.001), whereas patients infected by any other bacteria or fungi had about four times lower odds of the development of late VAP in comparison to Acinetobacter baumannii (p = 0.02). Patients with results in APACHE from 20 to 24 and from 25 to 29 had 13% and 21%, respectively, odds of the development of late VAP in comparison to patients with APACHE II scores ranging from 10 to 19 (respectively, p = 0.006; p = 0.028). Conclusions: The development of VAP is impacted by many factors, the monitoring of which has to be included in prophylactics and treatment.
Collapse
Affiliation(s)
- Lucyna Ścisło
- Department of Clinical Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, 31-501 Krakow, Poland; (L.Ś.); (E.W.); (M.K.)
| | - Elżbieta Walewska
- Department of Clinical Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, 31-501 Krakow, Poland; (L.Ś.); (E.W.); (M.K.)
| | - Iwona Bodys-Cupak
- Laboratory of Theory and Fundamentals of Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, 31-126 Krakow, Poland
- Correspondence:
| | - Agnieszka Gniadek
- Departement of Nursing Management and Epidemiology Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, 31-501 Krakow, Poland;
| | - Maria Kózka
- Department of Clinical Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, 31-501 Krakow, Poland; (L.Ś.); (E.W.); (M.K.)
| |
Collapse
|
16
|
Kumari M, Verma S, Venkatesh V, Gupta P, Tripathi P, Agarwal A, Siddiqui SS, Arshad Z, Prakash V. Emergence of blaNDM-1 and blaVIM producing Gram-negative bacilli in ventilator-associated pneumonia at AMR Surveillance Regional Reference Laboratory in India. PLoS One 2021; 16:e0256308. [PMID: 34495985 PMCID: PMC8425556 DOI: 10.1371/journal.pone.0256308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/03/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Ventilator-associated pneumonia (VAP) may be a life threatening nosocomial infection encountered in intensive care units. Currently the emergence of carbapenem-resistant Gram-negative pathogens has become worrisome threat worldwide. MATERIAL AND METHODS Endotracheal aspirates samples were collected from patients who were under mechanical ventilation for > 48 h. The bacterial isolates were identified by MALDI-TOF-MS and antibiotic susceptibility testing performed. All carbapenem resistant isolates were tested by Modified Hodge test (MHT), modified carbapenem inactivation method (mCIM), and EDTA-CIM (eCIM) and PCR were performed to detect blaIMP, blaVIM and blaNDM producing MBL genes. RESULTS VAP occurred in 172/353(48.7%), 23.3% had early-onset VAP and 76.7% had late-onset VAP. Males (69.2%) were found to suffer more from VAP. Prior antibiotic therapy, CPI>6, prior surgery and tracheostomy were associated with VAP. The mortality in VAP (58.1%) contrasted with non-VAP (40%). 99/169 (58.6%) Gram-negative isolates were resistant to carbapenems. Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae were common pathogens found in late onset VAP, whereas K. pneumoniae, A. baumannii and Staphylococcus aureus were common in early onset VAP. The PCR results detected blaNDM in 37/172(21.5%) and blaVIM in 30/172(17.4%); 15/172(8.7%) isolates carried both genes. CONCLUSION The blaNDM-1 and blaVIM genes are the main antibiotic-resistance genes that induce resistance patterns to carbapenems in VAP, highlighting CRE strains of potential public health concern and therapeutic challenge. Diagnostic laboratories in India must get on high caution for early MBL detection as it may limit the wide dispersal of MBL genes.
Collapse
Affiliation(s)
- Mithlesh Kumari
- Department of Microbiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Sheetal Verma
- Department of Microbiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Vimala Venkatesh
- Department of Microbiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Prashant Gupta
- Department of Microbiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Piyush Tripathi
- Department of Microbiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Avinash Agarwal
- Department of Critical Care Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Suhail Sarwar Siddiqui
- Department of Critical Care Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Zia Arshad
- Department of Anesthesiology & Critical Care, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Ved Prakash
- Department of Pulmonary & Critical Care Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
17
|
Maki G, Zervos M. Health Care-Acquired Infections in Low- and Middle-Income Countries and the Role of Infection Prevention and Control. Infect Dis Clin North Am 2021; 35:827-839. [PMID: 34362546 PMCID: PMC8331241 DOI: 10.1016/j.idc.2021.04.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Health care-associated infections (HAIs) account for many morbidity and mortality worldwide, with disproportionate adverse effects in low- and middle-income countries (LMIC). Many factors contribute to the impact in LMIC, including lack of infrastructure, inconsistent surveillance, deficiency in trained personnel and infection control programs, and poverty-related factors. Therefore, optimal approaches must be tailored for LMIC and balance effectiveness and cost in the control of HAIs.
Collapse
Affiliation(s)
- Gina Maki
- Division of Infectious Diseases, Henry Ford Hospital, CFP-3, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
| | - Marcus Zervos
- Division of Infectious Diseases, Henry Ford Hospital, Wayne State University, CFP-3, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| |
Collapse
|
18
|
Hassan A, Lai W, Alison J, Huang S, Milross M. Effect of intrapulmonary percussive ventilation on intensive care unit length of stay, the incidence of pneumonia and gas exchange in critically ill patients: A systematic review. PLoS One 2021; 16:e0255005. [PMID: 34320018 PMCID: PMC8318278 DOI: 10.1371/journal.pone.0255005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background Pulmonary complications such as pneumonia, pulmonary atelectasis, and subsequent respiratory failure leading to ventilatory support are a common occurrence in critically ill patients. Intrapulmonary percussive ventilation (IPV) is used to improve gas exchange and promote airway clearance in these patients. The current evidence regarding the effectiveness of intrapulmonary percussive ventilation in critical care settings remains unclear. This systematic review aims to summarise the evidence of the effectiveness of intrapulmonary percussive ventilation on intensive care unit length of stay (ICU-LOS) and respiratory outcomes in critically ill patients. Research question In critically ill patients, is intrapulmonary percussive ventilation effective in improving respiratory outcomes and reducing intensive care unit length of stay. Methods A systematic search of intrapulmonary percussive ventilation in intensive care unit (ICU) was performed on five databases from 1979 to 2021. Studies were considered for inclusion if they evaluated the effectiveness of IPV in patients aged ≥16 years receiving invasive or non-invasive ventilation or breathing spontaneously in critical care or high dependency units. Study titles and abstracts were screened, followed by data extraction by a full-text review. Due to a small number of studies and observed heterogeneities in the study methodology and patient population, a meta-analysis could not be included in this review. Outcomes of interest were summarised narratively. Results Out of 306 identified abstracts, seven studies (630 patients) met the eligibility criteria. Results of the included studies provide weak evidence to support the effectiveness of intrapulmonary percussive ventilation in reducing ICU-LOS, improving gas exchange, and reducing respiratory rate. Interpretation Based on the findings of this review, the evidence to support the role of IPV in reducing ICU-LOS, improving gas exchange, and reducing respiratory rate is weak. The therapeutic value of IPV in airway clearance, preventing pneumonia, and treating pulmonary atelectasis requires further investigation.
Collapse
Affiliation(s)
- Anwar Hassan
- Nepean Hospital, Nepean Blue Mountains Local Health District, Penrith, NSW, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- * E-mail:
| | - William Lai
- Nepean Hospital, Nepean Blue Mountains Local Health District, Penrith, NSW, Australia
| | - Jennifer Alison
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Stephen Huang
- Nepean Hospital, Nepean Blue Mountains Local Health District, Penrith, NSW, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Maree Milross
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| |
Collapse
|
19
|
Saharman YR, Karuniawati A, Severin JA, Verbrugh HA. Infections and antimicrobial resistance in intensive care units in lower-middle income countries: a scoping review. Antimicrob Resist Infect Control 2021; 10:22. [PMID: 33514432 PMCID: PMC7844809 DOI: 10.1186/s13756-020-00871-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 12/22/2020] [Indexed: 01/18/2023] Open
Abstract
Background Intensive care units (ICUs) in lower-middle income countries (LMICs) are suspected to constitute a special risk for patients of acquiring infection due to multiple antibiotic resistant organisms. The aim of this systematic scoping review was to present the data published on ICU-acquired infections and on antimicrobial resistance observed in ICUs in LMICs over a 13-year period. A systematic scoping review was conducted according to the PRISMA extension guideline for scoping reviews and registered in the Open Science Framework.
Main body of the abstract Articles were sought that reported on ICU-acquired infection in LMICs between 2005 and 2018. Two reviewers parallelly reviewed 1961 titles and abstracts retrieved from five data banks, found 274 eligible and finally included 51. Most LMICs had not produced reports in Q1 or Q2 journals in this period, constituting a large gap in knowledge. However, from the reported evidence it is clear that the rate of ICU-acquired infections was comparable, albeit approximately 10% higher, in LMICs compared to high income countries. In contrast, ICU mortality was much higher in LMICs (33.6%) than in high income countries (< 20%). Multidrug-resistant Gram-negative species, especially Acinetobacter baumannii and Pseudomonas aeruginosa, and Klebsiella pneumoniae played a much more dominant role in LMIC ICUs than in those in high income countries. However, interventions to improve this situation have been shown to be feasible and effective, even cost-effective. Conclusions Compared to high income countries the burden of ICU-acquired infection is higher in LMICs, as is the level of antimicrobial resistance; the pathogen distribution is also different. However, there is evidence that interventions are feasible and may be quite effective in these settings. Protocol Registration The protocol was registered with Open Science Framework (https://osf.io/c8vjk)
Collapse
Affiliation(s)
- Yulia Rosa Saharman
- Department of Clinical Microbiology, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.,Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Anis Karuniawati
- Department of Clinical Microbiology, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Juliëtte A Severin
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - Henri A Verbrugh
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| |
Collapse
|
20
|
Farivar A, Sanagoo A, Jouybari L, Ali V, Moghaddam S, Rahmania A. Evaluation of pneumonia due to mechanical ventilation and its association with the severity of disease in patients admitted to intensive care unit. ACTA FACULTATIS MEDICAE NAISSENSIS 2021. [DOI: 10.5937/afmnai38-28766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Among the hospital-acquired infections, ventilator-associated pneumonia (VAP) has the highest mortality and morbidity rates. The aim of this study was to identify VAP in the intensive care unit (ICU) and its association with the severity of the disease. This descriptive-analytic study was conducted in Golestan University of Medical Sciences (Northern Iran). In the present study, 239 patients undergoing mechanical ventilation hospitalized in ICU were selected through non-random sampling. Data were recorded by using APACHE II criteria and diagnosis of VAP was made based on clinical criterion and physician confirmation. Data were analyzed by independent t-test, Chi-square test, Mann-Whitney test, and single-variable logistic test. The incidence of VAP was 19.2% and it was significantly related to mean arterial pressure (P = 0.035) and male sex (P = 0.122). There was a significant and direct correlation between the incidence of VAP and the increase in the value of gastric residual volume > 200 ml (P = 0.001). The findings of this study showed that male sex, increased arterial pressure, and gastric residual volume were the risk factors for the development of of VAP.
Collapse
|
21
|
Manchal N, Siriwardena M, Hay K, Shekar K, McNamara JF. Assessment of the Clinical Pulmonary Infection Scores for prediction of ventilator associated pneumonia in patients with out of hospital cardiac arrest. Infect Dis Health 2020; 26:48-54. [PMID: 32962955 DOI: 10.1016/j.idh.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/30/2020] [Accepted: 09/01/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients suffering out-of-hospital cardiac arrest (OHCA) are at an increased risk of aspiration pneumonitis and development of subsequent aspiration pneumonia. The diagnostic uncertainty in this context can lead to a large proportion receiving broad spectrum antibiotics. METHODS This was a three-year, retrospective cohort study of consecutive patients admitted with OHCA. Data were collected in an Australian tertiary centre intensive care unit (ICU) between December 2016-December 2019. We assessed the incidence of Ventilator associated pneumonia (VAP), admission Clinical Pulmonary Infection Scores (CPIS) in patients with OHCA and its' association with VAP at day 3 [1]. We also assessed antibiotics prescribing (timing of initiation and drug choice) and intensive care mortality relative to the day 1 CPIS. RESULTS Over the three years, 100 patients were admitted with OHCA. The incidence of VAP was 6%. The CPIS on admission was not associated with development of VAP at day 3 (p = 0.75) and no significant association was found between choice of antibiotic regimens and VAP incidence. Timing of initiation of antibiotics was associated with VAP (12hrs vs 48hrs, p = 0.035) but not the choice of antibiotic (penicillin and cephalosporins vs antipseudomonal antibiotics). CPIS score at day 1 was not associated with ICU mortality in a multivariate analysis. CONCLUSION We demonstrated a very low incidence of VAP in OHCA patients in comparison to published studies. In this context, there was no evidence for an association between CPIS score and VAP at day 3. The CPIS may have utility as a decision support tool for targeted antibiotic prescribing in this cohort.
Collapse
Affiliation(s)
- Naveen Manchal
- Department of Infectious Diseases, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.
| | - Maithri Siriwardena
- Adult Intensive Care Services, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Karen Hay
- QIMR Berghofer Medical Research Institute, Australia
| | - Kiran Shekar
- Adult Intensive Care Services, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia; University of Queensland, Brisbane, Queensland, Australia
| | - John F McNamara
- Department of Infectious Diseases, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia; University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
22
|
Sosa-Hernández O, Matías-Téllez B, Estrada-Hernández A, Cureño-Díaz MA, Bello-López JM. Incidence and costs of ventilator-associated pneumonia in the adult intensive care unit of a tertiary referral hospital in Mexico. Am J Infect Control 2019; 47:e21-e25. [PMID: 30981442 DOI: 10.1016/j.ajic.2019.02.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/27/2019] [Accepted: 02/27/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is defined as pneumonia that occurs after 48 hours of endotracheal intubation and initiation of mechanical ventilation. The aim of this work was to use a micro-costing method to calculate the costs generated in 2017 for the care of patients with VAP at the Hospital Juárez de México. METHODS We performed a cross-sectional, retrospective, analytical, and observational study of the databases of the registry of health care-associated infections (HAIs) in 2017, in addition to a micro-costing study. RESULTS We studied 48 VAP cases in an adult intensive care unit (AICU). In this period, 1668 ventilator days were identified, with an incidence rate of 28.8 per 1000 days. All cases were caused by multidrug-resistant (MDR) bacteria and the costs of their care exceeded the average costs for the use of antimicrobials. By calculating the profit on return as an association measure, we found that VAP caused by MDR bacteria confers 9 times the risk of increasing the costs of care above the expected average. CONCLUSIONS The cost for a case of VAP in the AICU is high and has an impact on the institutional budget. Control measures to prevent the spread of bacteria, particularly MDR bacteria, must be put into place in order to avoid increases in hospital stay costs and mortality.
Collapse
|
23
|
The Effects of Oral Care Protocol on the Incidence of Ventilation-Associated Pneumonia in Selected Intensive Care Units in Jordan. Dimens Crit Care Nurs 2019; 38:5-12. [PMID: 30499786 DOI: 10.1097/dcc.0000000000000334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study aims to evaluate the effects of oral care protocol on the incidence of ventilator-associated pneumonia (VAP) at selected intensive care units (ICUs) in Jordan using clinical pulmonary infection score. METHODS A quasi-experimental design was used, and 1 large teaching hospital from the Jordanian capital, along with 2 hospitals from the southern region, was selected. A total of 218 patients participated, among which VAP risk in 2 independent groups was evaluated through the Clinical Pulmonary Infection Score sheet. RESULTS The VAP incidence rate was significantly lower in the intervention group (n = 102) as compared with control group (n = 116) (21.6 vs 35.3, respectively; P = .018); in addition, ICU stay and intubation period were significantly shorter among the intervention group. A higher risk of VAP was independently predicted by previous lung diseases (odds ratio [OR], 1.441; 95% confidence interval [CI], 1.185-1.88), open suctioning system (OR, 2.536; 95% CI, 1.261-5.101), and duration of intubation (OR, 1.770; 95% CI, 0.845-2.220). The oral care protocol has effectively improved ventilated patients' oral health, which has statistically reduced the incidence of VAP. It occurred more frequently among patients who have lung disease and those who were intubated for more than 7 days and have an open suctioning system. CONCLUSION Health care teams should ensure that effective care protocol is implemented among patients.
Collapse
|
24
|
Ortiz-Mayorga JL, Pineda-Rodríguez IG, Dennis RJ, Porras A. Attributed costs of health care-associated infections in a Colombian hospital, 2011- 2015. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2019; 39:102-112. [PMID: 31021551 DOI: 10.7705/biomedica.v39i1.4061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Indexed: 06/09/2023]
Abstract
Introduction: The cost analysis of infections associated with health care represents a challenge for the health system in Colombia given their determinants. Objective: To determine the factors related to the increase and variability in the costs of hospital care for infections associated with health care in a fourth-level hospital in Bogotá from 2011 to 2015. Materials and methods: The costs of the care for 292 patients were analyzed including each of the activities carried out since the suspicion of the infectious disease until its resolution. These costs were standardized to the value of the Instituto de Seguros Sociales tariff manual adjusted by the annual consumer price index for health until 2014. The factors related to the increase in management costs were identified using a conditional logistic regression model. Results: A hospital stay of nine days or more prior to the infection was a factor associated with the increase of direct costs in the management of infections associated with health care (OR=2.06; 95% CI: 1.11-3.63). The median cost of the infections was COP $1.190.879. The antibiotic treatment represented 41% of the total value of the treatment, followed by laboratory tests with a cost equivalent to 13.5%. Conclusions: We found a relationship between the cost of the management of infections associated with health care and the hospital stay prior to their appearance. The pathological antecedents of the patients were not related to the increase in the cost.
Collapse
|
25
|
Liu Q, Yang J, Zhang J, Zhao F, Feng X, Wang X, Lyu J. Description of Clinical Characteristics of VAP Patients in MIMIC Database. Front Pharmacol 2019; 10:62. [PMID: 30778301 PMCID: PMC6369200 DOI: 10.3389/fphar.2019.00062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 01/18/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Ventilator-associated pneumonia (VAP) is a common and serious nosocomial infection of intensive-care units (ICUs). Accurate, timely diagnosis enables early VAP patients to receive appropriate therapies and reduce the occurrence of complication. However, so far clinical datas regarding the epidemiology and mortality of VAP are still limited. Medical Information Mart for Intensive Care (MIMIC) database is a free, open and public resource about ICU research database. MIMIC database is a free, open, public database that collects information on more than 40,000 ICU patients who are predominantly white people. Therefore, the purpose of the present study is to observe and describe the clinical characteristics of VAP patients in ICU from the MIMIC database. Method: A total of 418 patients were enrolled in the study. General information, ventilator use information, microbiology information, antibiotic use information, and some nursing-related information were extracted to describe and analyze the clinical features of VAP patients. Results: The results of the study showed that patients with one or three pathogens were the most. The main pathogens were YEAST (16.71%), STAPH AUREUS COAG+ (11.63%), Staphylococcus, COAGULASE NEGATIVE (8.68%), GRAM NEGATIVE ROD (S) (6.14%), and Pseudomonas aeruginosa (5.73%). Patients using 4 antibiotics were the most. The top five antibiotics in the largest proportion were synthetic antibacterials (24.66%), peptides (20.13%), cephalosporins (19.60%), penicillins (13.54%), and aminoglycosides (5.27%). Conclusion: This study summarizes the common pathogens of VAP and the antibiotics commonly used in the treatment of VAP by describing the clinical information of 418 patients with VAP in the MIMIC database. In clinical treatment, we should pay attention to aseptic operation, develop appropriate antibacterial measures, closely monitor the pathogens of VAP infection, and use antibiotics in a timely manner to control the occurrence and development of VAP.
Collapse
Affiliation(s)
- Qingqing Liu
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Jin Yang
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Jun Zhang
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Fanfan Zhao
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Xiaojie Feng
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Xue Wang
- ICU, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jun Lyu
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| |
Collapse
|
26
|
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.
Collapse
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
| |
Collapse
|
27
|
Kupeli I, Salcan S, Kuzucu M, Kuyrukluyıldız U. Can endocan be a new biomarker in ventilator-associated pneumonia? Kaohsiung J Med Sci 2018; 34:689-694. [DOI: 10.1016/j.kjms.2018.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/03/2018] [Accepted: 07/12/2018] [Indexed: 12/22/2022] Open
|
28
|
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.
Collapse
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
| |
Collapse
|
29
|
Dat VQ, Huong VTL, Turner HC, Thwaites L, van Doorn HR, Nadjm B. Excess direct hospital cost of treating adult patients with ventilator associated respiratory infection (VARI) in Vietnam. PLoS One 2018; 13:e0206760. [PMID: 30379956 PMCID: PMC6209379 DOI: 10.1371/journal.pone.0206760] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/18/2018] [Indexed: 12/18/2022] Open
Abstract
Introduction Ventilator associated respiratory infections (VARIs) are the most common hospital acquired infections in critical care worldwide. This work aims to estimate the total annual direct hospital cost of treating VARI throughout Vietnam. Methods A costing model was constructed to evaluate the excess cost of diagnostics and treatment of VARI in Vietnam. Model inputs included costs for extra lengths of stay, diagnostics, VARI incidence, utilisation of ventilators and antibiotic therapy. Results With the current VARI incidence rate of 21.7 episodes per 1000 ventilation-days, we estimated 34,428 VARI episodes in the 577 critical care units in Vietnam per year. The extra cost per VARI episode was $1,174.90 and the total annual excess cost was US$40.4 million. A 1% absolute reduction in VARI incidence density would save US$1.86 million annually. For each episode of VARI, the share of excess cost components was 45.1% for critical care unit stay and ventilation, 3.7% for diagnostics and 51.1% for extra antimicrobial treatment. Conclusions At the current annual government health expenditure of US$117 per capita, VARI represents a substantial cost to the health service in Vietnam. Enhanced infection prevention and control and antimicrobial stewardship programmes should be implemented to reduce this.
Collapse
Affiliation(s)
- Vu Quoc Dat
- Department of Infectious Diseases, Hanoi Medical University, Hanoi, Vietnam
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam
- * E-mail: ,
| | - Vu Thi Lan Huong
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Hugo C. Turner
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Louise Thwaites
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - H. Rogier van Doorn
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Behzad Nadjm
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
30
|
Al-Abdely HM, Khidir Mohammed Y, Rosenthal VD, Orellano PW, ALazhary M, Kaid E, Al-Attas A, Hawsawi G, Kelany A, Hussein B, Esam B, Altowerqi R, Alkamaly MA, Tawfic NA, Cruzpero E, Al Rashidi RM, Thomas R, Molano AM, Al Enazy HA, Al Adwani FM, Casuyon Pahilanga AM, Alatawi S, Nakhla R, Al Adwani FM, Gasmin Aromin R, Balon Ubalde E, Hanafy Diab H, Kader NA, Hassan Assiry IY, Sawan FA, Ammari HE, Mashiakhy AM, Santiago EB, Chua CM, Dalis IM, Arishi HM, Lozada R, Al-Zaydani Asiri IA, Ahmed H, Jarie A, Al-Qathani AS, Al-Alkami HY, AlDalaton M, Alih SJ, Alaliany MJ, Helali NJ, Sindayen G, Malificio AA, Al Dossari HB, Algethami AG, Mohamed D, Yanne L, Tan A, Babu S, Abduljabbar SM, Rushdi H, Fernandez J, Hussain WM, Rajavel RD, Bukhari SZ, Turkistani AA, Mushtaq JJ, Albeladi E, Aboushoushah S, Qushmaq N, Shyrine L, Philipose J, Raees M, AbdulKhalik NS, Madco M, Abdulghany M, Manao A, Acostan C, Safwat R, Halwani M, Abdul Aal NA, Thomas A, Abdulatif SM, Ariola NC, Mutwalli AH, Ariola N, Bohlega E, Simon S, Damlig E, Elsherbini SG, Krishne IT, Abraham S, Ali Karrar MA, Gosn NA, Al Hindi AA, Jaha RN, AlQahtani SM, Abdul Aziz AO, Demaisip NL, Laungayan Cortez E, Cabato AF, Gonzales Celiz JM, Al Raey MA, Al Darani SA, Aziz MR, Manea BA, Samy E, Briones S, Krishnan R, Raees SS, Tabassum K, Ghalilah KM, Alradady M, Al Qatri A, Chaouali M, Elsisi M, Aldossary HA, Al-Suliman S, Al Talib AA, Albaghly N, Haqlre Mia ME, Al-Gethamy MM, Alamri DM, Al-Saadi AS, Ayugat EP, Al Hazazi NA, Al Hussain MI, Caminade Y, Santos AJ, Abdulwahab MH, Al-Garni BT. Impact of the International Nosocomial Infection Control Consortium (INICC)’s multidimensional approach on rates of ventilator-associated pneumonia in intensive care units in 22 hospitals of 14 cities of the Kingdom of Saudi Arabia. J Infect Public Health 2018; 11:677-684. [DOI: 10.1016/j.jiph.2018.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 01/09/2018] [Accepted: 06/05/2018] [Indexed: 01/30/2023] Open
|
31
|
Is the Venner-PneuX Endotracheal Tube System a Cost-Effective Option for Post Cardiac Surgery Care? Ann Thorac Surg 2018; 106:757-763. [DOI: 10.1016/j.athoracsur.2018.03.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 02/15/2018] [Accepted: 03/20/2018] [Indexed: 11/19/2022]
|
32
|
Rosenthal VD, Desse J, Maurizi DM, Chaparro GJ, Orellano PW, Chediack V, Cabrera R, Golschmid D, Silva CG, Vimercati JC, Stagnaro JP, Perez I, Spadaro ML, Montanini AM, Pedersen D, Paniccia TL, Ríos Aguilera AM, Cermesoni R, Mele JI, Alda E, Paldoro AE, Ortta AR, Cooke B, García MC, Obed MN, Domínguez CV, Saúl PA, Rodríguez del Valle MC, Bianchi AC, Alvarez G, Pérez R, Oyola C. Impact of the International Nosocomial Infection Control Consortium's multidimensional approach on rates of ventilator-associated pneumonia in 14 intensive care units in 11 hospitals of 5 cities within Argentina. Am J Infect Control 2018; 46:674-679. [PMID: 29329916 DOI: 10.1016/j.ajic.2017.11.021] [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] [Received: 09/18/2017] [Revised: 11/22/2017] [Accepted: 11/22/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach (IMA) on ventilator-associated pneumonia (VAP) rates in 11 hospitals within 5 cities of Argentina from January 2014-April 2017. METHODS A multicenter, prospective, before-after surveillance study was conducted through the use of International Nosocomial Infection Control Consortium Surveillance Online System. During baseline, we performed outcome surveillance of VAP applying the definitions of the Centers for Disease Control andPrevention's National Healthcare Safety Network. During intervention, we implemented the IMA, which included a bundle of infection prevention practice interventions, education, outcome surveillance, process surveillance, feedback on VAP rates and consequences, and performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention. RESULTS We recorded 3,940 patients admitted to 14 intensive care units. At baseline, there were 19.9 VAPs per 1,000 mechanical ventilator (MV)-days-with 2,920 MV-days and 58 VAPs, which was reduced during intervention to 9.4 VAPs per 1,000 MV-days-with 9,261 MV-days and 103 VAPs. This accounted for a 52% rate reduction (incidence density rate, 0.48; 95% confidence interval, 0.3-0.7; P .001). CONCLUSIONS Implementing the IMA was associated with significant reductions in VAP rates in intensive care units within Argentina.
Collapse
|
33
|
Ju M, Hou D, Chen S, Wang Y, Tang X, Liu J, Chen C, Song Y, Li H. Risk factors for mortality in ICU patients with Acinetobacter baumannii ventilator-associated pneumonia: impact of bacterial cytotoxicity. J Thorac Dis 2018; 10:2608-2617. [PMID: 29997922 DOI: 10.21037/jtd.2018.04.86] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Acinetobacter baumannii (A. baumannii) ventilator-associated pneumonia (VAP) in intensive care unit (ICU) is associated with high morbidity and mortality in patients with critical illness. However, the literatures that focused on the short-term prognosis and the risk factors for mortality are limited. The aim of this study was to evaluate the risk factors for mortality in ICU patients with A. baumannii VAP. Methods A retrospective cohort study was conducted in the medical/surgical ICU at Zhongshan Hospital in Shanghai, China. Adult patients meeting the criteria of A. baumannii VAP from January 2012 to October 2015 were enrolled. Apart from collecting clinical and microbiologic data, we performed biofilm-formation and cytotoxicity testing using A. baumannii strains which are isolated from patients. Multivariate logistic regression analysis was used to determine the independent risk factors for 30-day mortality in ICU. Results Seventy-eight patients were included in this study. The 30-day mortality rate in ICU for the patients was 37.2%. Multivariate analysis revealed that short-term mortality was significantly associated with prior surgery [OR, 0.277; 95% confidence interval (CI), 0.089-0.866; P=0.027], higher APACHEII score (OR, 1.140; 95% CI, 1.007-1.291; P=0.038) and an increased bacterial cytotoxicity (OR, 1.029 ; 95% CI, 1.001-1.058; P=0.047). Conclusions The main finding of our study was that increased bacterial cytotoxicity might be a risk factor for short-term mortality in ICU patients with A. baumannii VAP.
Collapse
Affiliation(s)
- Mohan Ju
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Dongni Hou
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Shu Chen
- Department of Infectious Disease, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Ying Wang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xinjun Tang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jie Liu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Cuicui Chen
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yuanlin Song
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Huayin Li
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| |
Collapse
|
34
|
Alja'afreh MA, Mosleh SM, Habashneh SS. Nurses' perception and attitudes towards oral care practices for mechanically ventilated patients. Saudi Med J 2018; 39:379-385. [PMID: 29619490 PMCID: PMC5938652 DOI: 10.15537/smj.2018.4.21749] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/28/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To explore the perception and attitudes of intensive care unit (ICU) nurses towards oral care practice for mechanically ventilated (MV) patients. METHOD A descriptive cross-sectional design was used in this study. A convenience sample of 96 ICU nurses completed a questionnaire on their perception and attitudes towards oral care. The study setting was 3 representative Jordanian hospitals in Al-Karak and the capital, Amman, over a 6-month period between February and September 2016. RESULTS Ninety-six nurses participated in the study. The response rate was 76.8%. The results revealed that 65% only follow a specific oral care protocol. Nurses did not adhere to minimal standards. Although nurses' attitude towards oral care was strongly positive, 68% of them perceived it as an unpleasant task and 29% agreed that they had insufficient training; 78% agreed to learn more about the best way to perform oral care. Standard descriptive statistics were calculated for all baseline information (sociodemographic characteristics). Binary variables were expressed as proportions, and normally distributed continuous variables as means and standard deviations. CONCLUSION The poor perception and attitudes of ICU nurses regarding oral care for MV patients require the urgent attention of clinical administrators. In-hospital training regarding oral care protocol could improve nurses' perception and attitudes.
Collapse
Affiliation(s)
- Mahmoud A Alja'afreh
- Department of Adult Health Nursing, Faculty of Nursing, Mutah University, Alkarak, Jordan. E-mail.
| | | | | |
Collapse
|
35
|
Impact of selective digestive decontamination without systemic antibiotics in a major heart surgery intensive care unit. J Thorac Cardiovasc Surg 2018; 156:685-693. [PMID: 29628347 DOI: 10.1016/j.jtcvs.2018.02.091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 01/22/2018] [Accepted: 02/01/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE The incidence density of ventilator-associated pneumonia (VAP) is higher in patients undergoing major heart surgery than in other populations, despite the introduction of bundles of preventive measures, because many risk factors are not amenable to intervention. Selective digestive decontamination (SDD) has been shown to be efficacious for decreasing the frequency of VAP, although it has not been incorporated into the routine of most intensive care units. The objective of our study was to evaluate the efficacy of SDD without parenteral antibiotics for preventing VAP in a major heart surgery intensive care unit. METHODS We compared the incidence of VAP before the introduction of SDD (17 months) and during the 17 months after the introduction of SDD and examined its ecologic influence. RESULTS The rates of VAP in the overall population before and during the intervention were 16.26/1000 days and 6.80 episodes/1000 days of mechanical ventilation, respectively (P = .01). The rates of VAP in the 173 patients remaining under mechanical ventilation > 48 hours after surgery were, respectively, 25.85/1000 days of mechanical ventilation versus 12.06 episodes/1000 days of mechanical ventilation (P = .04). We found a significant reduction in the number of patients with multidrug-resistant microorganisms (P = .01) in the second period of the study. CONCLUSIONS Our study shows that SDD without parenteral antibiotics can reduce the incidence of VAP in high-risk patients after major heart surgery, with no significant ecologic influence.
Collapse
|
36
|
Prospective observational study to compare oral topical metronidazole versus 0.2% chlorhexidine gluconate to prevent nosocomial pneumonia. Am J Infect Control 2016; 44:1116-1122. [PMID: 27317405 DOI: 10.1016/j.ajic.2016.03.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 03/08/2016] [Accepted: 03/08/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Nosocomial pneumonia is one of the most common health care-associated infections in intensive care units (ICUs) worldwide, attributing to high morbidity and mortality. Our study aim is to investigate the effectiveness of oral hygiene with 0.2% chlorhexidine gluconate (CHX) and 0.08% metronidazole (MDE) influencing the microbiologic epidemiology and incidence of nonintubation pneumonia (NIP) and ventilator-associated pneumonia (VAP). METHODS Patients who stayed >48 hours in the emergency ICU between 2008 and 2012 were enrolled and provided oral hygiene by swabbing with 0.08% MDE twice daily until discharge or death during the first year (period M), whereas CHX was applied during the following 3 years (period C). The incidence and microbiologic epidemiology of NIP and VAP were studied. RESULTS There were 873 patients enrolled. There were 44 episodes of NIP and 25 episodes of VAP that occurred among 212 patients in period M, and 84 episodes of NIP and 49 episodes of VAP occurred among 661 patients in period C. Overall, the rate of NIP and VAP decreased year by year. Acinetobacter baumannii was the most frequently identified bacteria for NIP (22.9%) and VAP (25.3%), with an annual ascent. Few changes were observed on bacteria distribution for NIP and VAP. CONCLUSIONS Oral hygiene with CHX, having reduced the incidence of nosocomial pneumonia among critical ill patients, suggests a benefit of oral hygiene in decreasing the incidence of nosocomial pneumonia, including VAP in ICUs, but not bacterial epidemiology.
Collapse
|
37
|
Bardossy AC, Zervos J, Zervos M. Preventing Hospital-acquired Infections in Low-income and Middle-income Countries. Infect Dis Clin North Am 2016; 30:805-18. [DOI: 10.1016/j.idc.2016.04.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
38
|
|
39
|
Rosenthal VD, Udwadia FE, Kumar S, Poojary A, Sankar R, Orellano PW, Durgad S, Thulasiraman M, Bahirune S, Kumbhar S, Patil P. Clinical impact and cost-effectiveness of split-septum and single-use prefilled flushing device vs 3-way stopcock on central line-associated bloodstream infection rates in India: a randomized clinical trial conducted by the International Nosocomial Infection Control Consortium (INICC). Am J Infect Control 2015; 43:1040-5. [PMID: 26164769 DOI: 10.1016/j.ajic.2015.05.042] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/22/2015] [Accepted: 05/26/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Three-way stopcocks (3WSCs) are open systems used on intravenous tubing. Split septums (SSs) are closed systems with prepierced septums. Single-use prefilled flushing devices (SUFs) carry a lower risk of contamination than standard intravenous flushing. 3WSC and standard flushing are widely used in developing countries. This is the first randomized clinical trial (RCT) to compare rates of central line-associated bloodstream infection (CLABSI) between patients using an SS + SUF and those using a 3WSC. METHODS An RCT with 1096 patients in 5 adult intensive care units was conducted between April 2012 and August 2014 to evaluate their impact on CLABSI rates. Centers for Disease Control and Prevention/National Healthcare Safety Network definitions were applied and International Nosocomial Infection Control Consortium methodology were followed. RESULTS The study cohort included 547 patients and 3619 central line (CL)-days for the SS + SUF group, and 549 patients and 4061 CL-days for the 3WSC group. CLABSI rates were 2.21 per 1000 CL-days for SS + SUF and 6.40 per 1000 CL-days for 3WSC (relative risk, 0.35; 95% confidence interval [CI], 0.16-0.76; P = .006). The SS + SUF group had significantly better cumulative infection-free catheter survival compared with the 3WSC group (hazard ration, 0.33; 95% CI, 0.15-0.73; P = .006). Using an SS + SUF represents savings of $402.88 and an increase in quality-adjusted life years of 0.0008 per patient. For each extra dollar invested in an SS + SUF, $124 was saved. CONCLUSION The use of SS + SUF is cost-effective and associated with a significantly lower CLABSI rate compared with the use of 3WSC.
Collapse
|