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ventilation associated pneumonia

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انتخاب همه

Subglottic Secretion Drainage to Prevent Ventilator-Associated Pneumonia in Mechanically Ventilated Adult Patients: A Systematic Review and Meta-Analysis

Farshid Rahimibashar, Zahra Farsi, Zahra Danial, Sahar Dalvand, Amir Vahedian-Azimi Amir Vahedian-Azimi *

Trauma Monthly, Volume:24 Issue: 4, Jul-Aug2019, P 7

Background

Patients requiring invasive mechanical ventilation in the intensive care unit (ICU) are at risk for ventilator-associated pneumonia (VAP).

Objectives

To summarize the results of published, randomized, clinical trials (RCTs), a meta-analysis was performed to examine the effect of subglottic secretion drainage (SSD) on the prevalence and outcomes of VAP in adult patients undergoing mechanical ventilation.

Methods

A comprehensive search based on specific terms was performed as a systematic review and meta-analysis by a computerized database search in the national and international databases including MagIran, SID, Scopus, PubMed, ISI Web of Knowledge, ScienceDirect, Google Scholar, Cochrane Central, and IRCT as well as references from 1990 to 2018 in English and Persian languages. RCTsof SSDwere considered as common careof adultpatientsundergoingmechanical ventilationin the currentmeta-analysis. Data analysis was carried out through the random and fixed effects model, and the heterogeneity was investigated by I2 and Q-Cochrane index. The data were analyzed using STATA 11.

Results

A total of 24 eligible RCTs with 2434 patients were identified. The overall risk ratio for VAP was 14.7 (95% confidence interval (CI): 11.1 - 18.4); mortality 25.8 (95% CI: 17.3 - 34.3); length of ICU stay 13.4 (95% CI: 7.8 - 18.9) and hospital stay 23.2 (95% CI: 12.5 - 33.9); ventilation days 14.9 (95% CI: 7.3 - 22.6); airway secretion 10.2 (95% CI: 4.9 - 15.5); and APACHEII 19.5 (95% CI: 14.6 - 24.3).

Conclusions

SSD is recommended to prevent VAP, and reduce mortality rate and the ICU LOS, especially in the high-risk patients undergoing mechanical ventilation for a long period of time.

Keywords: Intensive Care Unit, Lengths of Stay, Mechanical Ventilation, Subgluttic Secretion Drainage, Suctioning, Ventilation-associated Pneumonia

Abstract View Paper Review Article Original: English
بررسی ارتباط ضایعات دهانی و پنومونی زودرس وابسته به تهویه مکانیکی در بیماران تحت تهویه مکانیکی بخش مراقبت های ویژه

معصومه معصومی، نسرین حنیفی *، محمدرضا جمشیدی، سقراط فقیه زاده

مجله علوم مراقبتی نظامی، سال سوم شماره 2 (تابستان 1395)، صص 107 -114

مقدمه
بهداشت دهان یکی از مراقبت های ضروری در بیماران بستری در بخش های ویژه است. بهداشت دهان نامناسب منجر به عوارض ناخوشایند دهانی در بیماران می شود که می تواند سایر ارگان ها مانند ریه را نیز درگیر نماید.
هدف
این مطالعه به منظور بررسی ارتباط ضایعات دهانی و پنومونی زودرس وابسته به تهویه مکانیکی طراحی شد.
مواد و روش ها
پژوهش حاضر یک مطالعه ی مقطعی از نوع توصیفی– تحلیلی بود که در سال 1392 انجام شد. در این مطالعه 74 بیمار مورد بررسی قرار گرفتند. ابزارهای مورد استفاده شامل اطلاعات جمعیت شناختی، مقیاس Beck وCPIS بود. میزان ابتلا به ضایعات دهانی و پنومونی در روزهای سوم و چهارم بستری بودن بیماران و نیز ارتباط این دو متغیر با استفاده از آمار توصیفی و آزمون مک نمار مورد تجزیه و تحلیل قرار گرفت.
یافته ها
نتایج نشان داد در روز سوم 7/79% و در روز چهارم 54/90% از بیماران به ضایعات دهانی مبتلا شدند. میزان ابتلا به پنومونی نیز در روز سوم 4/5% و در روز چهارم 02/27% گزارش شد. بین ضایعات دهانی و ابتلا به پنومونی با آزمون مک-نمار در روز سوم با 001/0 P < و در روز چهارم با 001/0 P < ارتباط آماری معنادار نشان داده شد.
بحث و نتیجه گیری
توصیه می شود، پرستاران برای پیشگیری از پنومونی به بهداشت دهان بیماران تحت تهویه مکانیکی بیشتر توجه کنند، زیرا ابتلا به پنومونی، وابستگی بیشتر بیمار به دستگاه تهویه مکانیکی و افزایش طول مدت بستری را در پی خواهد داشت.

کلید واژگان: بخش مراقبت های ویژه، پنومونی وابسته به تهویه مکانیکی، تهویه مکانیکی، ضایعات دهانی

چکیده مشاهده متن زبان: فارسی

Investigation of the Relationship Between Oral Lesions and Early Pneumonia Associated with Mechanical Ventilation in Patients Undergoing Mechanical Ventilation in Intensive Care Unit

M. Masoumi, N. Hanifi*, Mr. Jamshidi, S. Faghihzadeh

Journal of Military Caring Sciences, Volume:3 Issue: 2, 2016, PP 107 -114

Introduction
Oral hygiene is one of the necessary cares for patients hospitalized in special wards. Improper oral hygiene leads to unpleasant oral side effects, which can also affect other organs such as the lungs.
Objective
This study was designed to investigate the relationship between oral lesions and early mechanical ventilation-associated pneumonia (VAP).
Materials And Methods
The present research was a cross-sectional study of the descriptive correlation type, comprised of 74 patientsd. The tools used included demographic information, Beck oral assessment scale (BOAS), and clinical pulmonary infection score (CPIS). The incidence of oral lesions and VAP in third and fourth days of patients hospitalization as well as their relationship were analyzed using McNemar test and descriptive statistics.
Results
The results showed that in the third day 79.7%, and in the fourth day 90.54% of patients were diagnosed with oral lesions. The rate of VAP was 5.4% in the third and 27.02% in the fourth days. There was a meaningful statistical association between VAP and oral lesions, shown by the Mc nemar test, in the third day with a PDiscussion and
Conclusion
It is recommended that nurses pay more attention to the oral hygiene of patients undergoing mechanical ventilation in order to prevent VAP, because the risk of VAP will lead to more dependence to ventilator for patients and increased length of stay.

Keywords: Oral lesions, Mechanical Ventilation Mechanical Ventilation, Intensive Care Unit, Ventilation Associated Pneumonia

Abstract View Paper Original: Persian
Evaluation of the Effect of Open and Closed Tracheal Suction on the Incidence of Ventilator Associated Pneumonia in Patients Admitted in the Intensive Care Unit

Nasim Alipour, Nahid Manouchehrian, Mehdi Sanatkar, Hassan Mohammadi Poor Anvari, Mohammad Sadegh Sanie Jahromy

Archives of Anesthesiology and Critical Care, Volume:2 Issue: 2, Spring 2016, PP 193 -196

Background
Nosocomial pneumonia is a prevalent complication in patients admitted to intensive care units (ICU). Endotracheal suction is used in cleaning the airways of secretions in patients under mechanical ventilation. Performing suction accurately is of great importance to prevent ventilation associated pneumonia. The purpose of this study was to compare the effect of open versus closed tracheal suction on the incidence of VAP.
Methods
This was a clinical trial study performed on 86 intubated patients in ICU. Patients of control group (n=43) underwent conventional open suction and case group (n=43) closed suction. After 72 hours, patients were assessed regarding VAP using clinical pulmonary infection score (CPIS).
Results
There was no significant difference regarding age (p=0.15) and gender (p=0.33) between the two groups. The incidence of ventilator associated pneumonia was significantly lower in closed method compared to the open method (p=0.016).
Conclusion
Closed tracheal suction compared to the open method was associated with lower incidence of VAP in patients of ICU.

Keywords: ventilation associated pneumonia, intensive care unit, nosocomial pneumonia

Abstract View Paper Original: English

نکته

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ventilation associated pneumonia