Effect of modified care bundle for prevention of ventilator-associated pneumonia in critically-ill neurosurgical patients
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: Care bundles for ventilator-associated pneumonia (VAP) have been shown to mini- mize the rate of VAP in critically ill patients. Standard care bundles may need to be modified in resource-constrained situations. The goal of this study was to see if our modified VAP-care bun- dles lowered the risk of VAP in neurosurgical patients. Methods: A prospective cohort study was conducted in mechanically ventilated neurosurgical patients. The VAP bundle was adjusted in the cohort group by increasing the frequency of inter- mittent endotracheal tube cuff pressure monitoring to six times a day while reducing oral care with 0.12% chlorhexidine to three times a day. The rate of VAP was compared to the historical control group. Results: A total of 146 and 145 patients were enrolled in control and cohort groups, respectively. The mean age of patients was 52±16 years in both groups (P=0.803). The admission Glasgow coma scores were 7.79±2.67 and 7.80±2.77 in control and cohort group, respectively (P=0.969). VAP was found in nine patients in control group but only one patient in cohort group. The occur- rence rate of VAP was significantly reduced in cohort group compared to control group (0.88/1,000 vs. 6.84/1,000 ventilator days, P=0.036). Conclusions: The modified VAP bundle is effective in lowering the VAP rate in critically ill neuro- surgical patients. It requires low budget and manpower and can be employed in resource-con- strained settings.
Abstract
Background: Care bundles for ventilator-associated pneumonia (VAP) have been shown to mini- mize the rate of VAP in critically ill patients. Standard care bundles may need to be modified in resource-constrained situations. The goal of this study was to see if our modified VAP-care bun- dles lowered the risk of VAP in neurosurgical patients. Methods: A prospective cohort study was conducted in mechanically ventilated neurosurgical patients. The VAP bundle was adjusted in the cohort group by increasing the frequency of inter- mittent endotracheal tube cuff pressure monitoring to six times a day while reducing oral care with 0.12% chlorhexidine to three times a day. The rate of VAP was compared to the historical control group. Results: A total of 146 and 145 patients were enrolled in control and cohort groups, respectively. The mean age of patients was 52±16 years in both groups (P=0.803). The admission Glasgow coma scores were 7.79±2.67 and 7.80±2.77 in control and cohort group, respectively (P=0.969). VAP was found in nine patients in control group but only one patient in cohort group. The occur- rence rate of VAP was significantly reduced in cohort group compared to control group (0.88/1,000 vs. 6.84/1,000 ventilator days, P=0.036). Conclusions: The modified VAP bundle is effective in lowering the VAP rate in critically ill neuro- surgical patients. It requires low budget and manpower and can be employed in resource-con- strained settings.
참고문헌 (31)
- Rello J, "Epidemiology and outcomes of ventilator-associated pneumonia in a large US database", Chest, 122, pp.2115~2121 (2002)
- Craven DE, "Epidemiology of ventilator-associated pneumonia", Chest, 117(4 Suppl 2), pp.186S~187S (2000)
- Martin-Loeches I, "New guidelines for hospital-acquired pneumonia", ventilator-associated pneumonia: USA vs. Europe, 2018, pp.24, 347~352
- Triamvisit S, "Results of an evidence-based care bundle for reducing ventilator-associated pneumonia(VAP)in neurosurgical patients", J Med Assoc Thai, 99, pp.1014~1019 (2016)
- Lorente L, "Continuous endotracheal tube cuff pressure control system protects against ventilator-associated pneumonia", Crit Care, 18, pp.R77~ (2014)
- Rouzé A, "Continuous control of tracheal cuff pressure: an effective measure to prevent ventilator-associated pneumonia?", Crit Care, 18, pp.512~ (2014)
- Magill SS, "Developing a new, national approach to surveillance for ventilator-associated events", Crit Care Med, 41, pp.2467~2475 (2013)
- Magill SS, "Changes in prevalence of health care-associated infections in U.S. hospitals", N Engl J Med, 379, pp.1732~1744 (2018)
- Li Y, "Incidence, risk factors, and outcomes of ventilator-associated pneumonia in traumatic brain injury: a meta-analysis", Neurocrit Care, 32, pp.272~285 (2020)
- Kourbeti IS, "Infections in traumatic brain injury patients", Clin Microbiol Infect, 18, pp.359~364 (2012)
- Nseir S, "Continuous control of tracheal cuff pressure and microaspiration of gastric contents in critically ill patients", Am J Respir Crit Care Med, 184, pp.1041~1047 (2011)
- Hamilton VA, "The role of the endotracheal tube cuff in microaspiration", Heart Lung, 41, pp.167~172 (2012)
- Vallés J, "Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia", Ann Intern Med, 122, pp.179~186 (1995)
- Rosenthal VD, "Impact of an infection control program on rates of ventilator-associated pneumonia in intensive care units in 2 Argentinean hospitals", Am J Infect Control, 34, pp.58~63 (2006)
- Ferreira CR, "The effectiveness of a bundle in the prevention of ventilator-associated pneumonia", Braz J Infect Dis, 20, pp.267~271 (2016)
- Jackson L, "Does oral care with chlorhexidine reduce ventilator-associated pneumonia in mechanically ventilated adults?", Br J Nurs, 28, pp.682~689 (2019)
- Kharel S, "Ventilator-associated pneumonia among ICU patients in WHO Southeast Asian region: a systematic review", PLoS One, 16, pp.e0247832~ (2021)
- Fortaleza CM, "Sustained reduction of healthcare-associated infections after the introduction of a bundle for prevention of ventilator-associated pneumonia in medical-surgical intensive care units", Braz J Infect Dis, 24, pp.373~379 (2020)
- Marjanovic N, "Multicentre randomized controlled trial to investigate the usefulness of continuous pneumatic regulation of tracheal cuff pressure for reducing ventilator-associated pneumonia in mechanically ventilated severe trauma patients: the AGATE study protocol", BMJ Open, 7, pp.e017003~ (2017)
- Segers P, "Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate : a randomized controlled trial", JAMA, 296, pp.2460~2466 (2006)
- Athiraman U, "Endotracheal cuff pressure changes with change in position in neurosurgical patients", Int J Crit Illn Inj Sci, 5, pp.237~241 (2015)
- Khan MU, "Measurement of endotracheal tube cuff pressure : instrumental versus conventional method", Saudi J Anaesth, 10, pp.428~431 (2016)
- Sultan P, "Endotracheal tube cuff pressure monitoring : a review of the evidence", J Perioper Pract, 21, pp.379~386 (2011)
- Jovanovic B, "Risk factors for ventilator-associated pneumonia in patients with severe traumatic brain injury in a Serbian trauma centre", Int J Infect Dis, 38, pp.46~51 (2015)
- Zhang TT, "The effectiveness of different concentrations of chlorhexidine for prevention of ventilator-associated pneumonia: a meta-analysis", J Clin Nurs, 23(11-12), pp.1461~1475 (2014)
- Chlebicki MP, "Topical chlorhexidine for prevention of ventilator-associated pneumonia : a meta-analysis", Crit Care Med, 35, pp.595~602 (2007)
- Chacko R, "Oral decontamination techniques and ventilator-associated pneumonia", Br J Nurs, 26, pp.594~599 (2017)
- DeRiso AJ 2nd, "Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery", Chest, 109, pp.1556~1561 (1996)
- Fourrier F, "Effects of dental plaque antiseptic decontamination on bacterial colonization and nosocomial infections in critically ill patients", Intensive Care Med, 26, pp.1239~1247 (2000)
- Houston S, "Effectiveness of 0.12% chlorhexidine gluconate oral rinse in reducing prevalence of nosocomial pneumonia in patients undergoing heart surgery", Am J Crit Care, 11, pp.567~570 (2002)
- Scannapieco FA, "A randomized trial of chlorhexidine gluconate on oral bacterial pathogens in mechanically ventilated patients", Crit Care, 13, pp.R117~ (2009)