Cuidados de enfermería en la prevención de la neumonía asociada a ventilación mecánica. Revisión sistemática

[Nursing care in the prevention of ventilator-associated pneumonia]

INTRODUCTION

Certain nursing interventions reduce the incidence of ventilator-associated pneumonia (VAP).

OBJECTIVES

a) to analyze in patients with more than 24 hours of invasive mechanical ventilation how frequently oral hygiene, oropharyngeal suction, turning and evaluation of the tolerance of enteral nutrition were performed according to established protocols; b) to record in these same patients endotracheal tube cuff pressures and the degrees of elevation of the head of the bed (HOB); c) to determine over the three months of the study the incidence density of VAP.

METHOD

This descriptive study was carried out in 26 patients. The nursing interventions of interest were recorded daily. Furthermore, endotracheal tube cuff pressures and the degrees of elevation of HOB were measured 3 times a day. Compliance with the established protocols was considered good when it reached ≥80%. Cases of VAP were determined using CDC criteria. The incidence density was calculated including all the patients (122) with mechanical ventilation during the study period.

RESULTS

Good compliance with the established protocols was achieved for oral hygiene in 23 patients, for oropharyngeal suction and for turning in 19 patients, and in all patients for the evaluation of the tolerance of enteral nutrition. In 214 measurements endotracheal tube cuff pressure was ≥ 20cm H20 and in 121 lower. In 79 measurements elevation of HOB was ≥30° and in 256 lower. The incidence density of VAP was 7.43/ 1.000 days of mechanical ventilation.

CONCLUSIONS

: For these nurse interventions aimed at preventing VAP, levels of compliance with established protocols were satisfactory. The incidence density of VAP was low and well within internationally established ranges. Nevertheless, the incidence of VAP could be further reduced with a better control of cuff pressures and by elevating the HOB to between 30° and 45°.

[Prevention of mechanical ventilator-associated pneumonia: a comparison of two different oral hygiene methods]

INTRODUCTION

Oral hygiene (OH) forms a part of the patient's safety in the prevention of mechanical ventilator-associated pneumonia (VAP). The dental plaque index (DP) is considered as a quality marker for OH.

HYPOTHESIS

The association of electric toothbrush and conventional OH in intubated patients decreases the DP and incidence of VAP.

OBJECTIVE

To verify the reduction of DP in patients receiving OH and electric toothbrush and its association with to the decrease of VAP incidence.

MATERIALS AND METHODS

A 3-year long randomized, single blind and prospective study conducted in a 14-bed polyvalent intensive care unit. Patients were included when there was more than 48hours of mechanical ventilation and no expected respiratory infection. Patients were randomized into two groups: Standard (OH with chlorhexidine) (GS) and Raspall (Standard OH with electric dental brush) (GR). The VAP was identified following clinical, medical and microbiological criteria. The DP and halitosis were observed daily. Oral and pharyngeal swabs were collected during the first 5 days.

RESULTS

147 patients were included. Mean age was 53.9±17.5. No significant differences were found in the VAP incidence between the two groups (OR=0.78; 95% IC, 0.36-1.68; p=0.56). The relation between halitosis and DP was p=0.7. The dental plaque index on the 5th day was 1.98 (n=60) in GR and 2.04 (n=57) in GS (p=0.3). The dental plaque index on the 10th day was 1.68 (n=29) in GR and 1.91 (n=32) in GS (p=0.7).

CONCLUSIONS

There is a tendency towards a decrease in the DP which is clearing in the GR group and no relation between VAP and greater DP or halitosis.