Clinical Study on Selective Decontamination of the Digestive Tract for Prevention of Ventilator-associated Pneumonia
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Objective:To investigate the clinical effects of selective decontamination of the digestive tract(SDD) combined with posture intervention for prevention of ventilator-associated pneumonia(VAP). Methods:A total of 75 patients with artificial airways during mechanical ventilation were randomly allocated into the trial group(n=39) and control group(n=36).The control group received no preventive measures but routine treatment and patients in the trial group lay in a semireclining position at an angle of 30°-45° and were administered with polymyxin E 100 mg,tobramycin 80 mg and amphotericin B 500 mg by using the nasogastric tube,and on the basis of the above mentioned treatment,the nasopharynx was smeared with those three kinds of antibiotic ointments,once every six hours. Results:Forty-two of the 75 patients developed VAP and the cumulative incidence of VAP was 56.0%.The incidence and cumulative incidence of VAP were respectively 5.1% and 35.9% in the trial group and those were respectively 33.3% and 77.8% in the control group within 5 days after mechanical ventilation.Both the incidence and cumulative incidence of VAP were lower in the trial group than those in the control group(P0.05 or P0.01).The number of days for mechanical ventilation,the length of ICU stay,and the ICU hospitalization expense were respectively18.5±3.1 days,34.1±5.9 days and 45,634 ± 465 Yuan in the trial group,significantly lower than the respective 27.9±4.0 days,43.8±6.4 days and 68,793 ± 762 Yuan in the control group(P0.05). Conclusion:SDD in combination with posture intervention can help to reduce the incidence of VAP,and susquently resulting in reduction of the number of days for mechanical ventilation and the ICU hospitalization expense during ICU stay for patients receiving mechanical ventilation.Keywords:
Ventilator-associated Pneumonia
Cumulative incidence
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OBJECTIVE To reduce the occurrence of lower respiratory tract infection(LRTI) associated with ventilator by adopting simple and effective methods.METHODS A11 patients supported by respiratory machine in ICU were divided into two groups ramdonly,one group treated with simple subglotfic secretion drainage and flushing ventilator associated pneumonia(VAP) while other group as control.The total number of cases were 320,which included 225 male and 95 female with the mean age 48±12.Periodically tests were done to two groups for their bacterial culture samples obtained from oropharynx,subglottic secretion and lower respiratory tract,also the time of occurrence of VAP and the case fatality rate were recorded.RESULTS Totally 34 cases occurred VAP in test group,which was significantly lower than that in control group(63 cases) Mortality of treated group(10.3%) was lower than that of control group(16.5%).MV time of treated group(9±14)d was shorter than that of control group(4.6±2.0)d,(P0.002).The onset of VAP was delayed in the treated group [VAP:(8.8±3.6)d]as compared with the control group [VAP:(4.6±2.0)d,P0.05].and statistic data was shown significantly.However,no significantly statistic differences were found in the lengths of hospital stay(28±25)d in treated group and control group(31±22)d,which shown P value for 0.563.CONCLUSION Simple subglottic secretion drainage and flushing can reduce the incidence of VAP and fatality rate,delay the onset of VAP and shorten MV time.
Case fatality rate
Ventilator-associated Pneumonia
Respiratory tract
Flushing
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Objective
To explore the appropriate frequency of ventilator tube replacement by researching the influence of different ventilator circuit change frequency on ventilator-associated pneumonia (VAP).
Methods
A prospective randomized sampling study was conducted. The patients undergoing invasive mechanical ventilation over or equal to 3 days admitted to emergency intensive care unit (EICU) of the First Affiliated Hospital of Kunming Medical University from December 2012 to December 2015 were enrolled. The patients were divided into 3, 7 and 10 days group according to the frequency of ventilator tube replacement. Bacteriology of ventilator tube and the incidence of VAP were compared among the groups.
Results
Ninety-eight patients were enrolled, mainly with the artificial airway of endotracheal intubation or tracheotomy, with 56 male and 42 female, aging 8 to 86 years with mean of (51.97±17.56) years. There were no statistical differences in gender, age, Glasgow coma scale (GCS) score, cough function and application of glucocorticoid, enteral nutrition, atomization and sedative therapy among three groups, indicating that the risk factors among three groups were consistent. The bacteria detection rates of extension tube, breathe out tube, breathe in tube, and hydrops collection cup were 36.7%, 36.7%, 33.3%, and 33.3% respectively in 3 days group, and they were 73.0%, 67.6%, 62.2%, and 62.2% in 7 days group respectively, and were all 90.3% in 10 days group. It was showed that the bacteria detection rate in different pipe parts was almost the same with the same change frequency, and the rate was higher with the longer usage of ventilator tube (χ2 values were 20.599, 19.879, 21.975, 21.975, all P = 0.000). The longer of the tube used time, the higher incidence of VAP. The incidence of VAP in 3, 7, 10 days groups were 26.7%, 59.5% and 77.4%, respectively, but there was statistically significant difference among all groups (χ2 = 30.486, P < 0.001). Based on the value of 3 days group, the incidence of VAP in the 7 days group was 15.950 folds of 3 days group, and the incidence of VAP in the 10 days group was 18.333 folds of the 3 days group (both P < 0.001).
Conclusion
This study suggests that the longer of pipeline using time, the more serious degree of bacterial contamination of pipeline, the higher incidence of VAP.
Key words:
Ventilator-associated pneumonia; Mechanical ventilation; Ventilator tube; Frequency of replacement
Ventilator-associated Pneumonia
Tracheotomy
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Endotracheal tube (ET) changes in patients plus the risk of airway injury and introducing endogenous oropharyngeal bacteria into patient9s lower airway. The interval of ET exchange in patients receiving prolonged mechanical ventilation (PMV) is currently based on clinician9s discretion in Taiwan and remains a dilemma of respiratory care. In this study, we would like to know whether it is safe to prolong the use of the ET without causing an increase in the incidence of ventilator associated pneumonia in patients under long term mechanical ventilator support. Methods: Eleven PMV patients were recruited from respiratory care wards (RCW) and divided into two groups by randomized complete block design. ET was changed either every 30 days (control group) or 90 days (experiment group). The incidence of VAP and cumulative rate of patients remaining free of VAP were assessed. Results: A total of 48 times of ET changes were completed in 11 patients. The incidence of VAP were 8.8% (3/34 times) in the control group and 42.9% (6/14 times) in the experiment group (P=.01). The cumulative rate of patients remaining free of VAP probability was better in the group of routinely exchanged every 30 days during the study period (P=.002). There were no statistically significant differences between the two groups including microorganisms that caused VAP, disease severity classification at VAP onset, transferred to ICU and hospital mortality. Conclusion: Routine 30 days exchange of ET could reduce the incidence of VAP when compare with prolonged ET exchange, but should be weighed on the possible risk of airway trauma during the invasive procedure.
Ventilator-associated Pneumonia
Endotracheal tube
Group B
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Objective:We studied the effect of the common oral remover(koutai)on morbidity of VAP in patient undergoing mechanical ventilation,in order to reveal the effect of oral nursing in preventing VAP.Method:40 patients undergoing mechanical ventilation were randomly divided into 2 groups(n=20).A group was koutai group,B group was controlled group,using saline.The removers were rigorously applied to tooth,gingival,buccal and tongue for no less 1 minute twice daily,Compared the morbidity of total VAP early VAP and delay VAP.Result:①Morbidity of total VAP in A group(61.3%)was fewer than in B group(80%).②Morbidity of early VAP in A group(37.36%)was fewer than in B group(70%).③Morbidity of delay VAP in A group(40%)was fewer than in B group(75%).But there was nostatistical difference(P0.05).Conclusion:Oral nursing with koutai can reduce early ventilator-associated pneumonia.
Ventilator-associated Pneumonia
Group B
Group A
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Ventilator-associated pneumonia (VAP) is a potentially preventable iatrogenic illness that may develop following mechanical ventilation. A bundle for the prevention of VAP consists of different measures which may vary between institutions, and may include: elevation of the head of the bed, oral care with chlorhexidine, subglottic suctioning, daily assessment for extubation and the need for proton-pump inhibitors, use of closed suction systems, and maintaining endotracheal cuff pressure at 25 cmH2O. Our aim was to determine the efficacy of a VAP prevention bundle, consisting of the above-mentioned measures, by evaluating the incidence of VAP before (no-VAP-B group) and after (VAP-B group) the introduction of the bundle. We retrospectively evaluated the data for patients who were mechanically ventilated with an endotracheal tube, in the period between 1 September and 31 December 2014 (no-VAP-B group, n = 55, 54.5% males, mean age 67.8 ± 14.5 years) and between 1 January to 30 April 2015 (VAP-B group, n = 74, 62.1% males, mean age 64.8 ± 13.7 years). There were no statistically significant differences between no-VAP-B and VAP-B groups in demographic data, intensive care unit (ICU) mortality, hospital mortality, duration of ICU treatment, and duration of mechanical ventilation. No significant differences in the rates of VAP and early VAP (onset ≤7 days after intubation) were found between no-VAP-B and VAP-B groups (41.8% versus 25.7%, p = 0.06 and 10.9% versus 12.2%, p > 0.99, respectively). However, a significant decrease in the late VAP (onset >8 days after intubation) was found in VAP-B group compared to no-VAP-B group (13.5% versus 30.9%, p = 0.027). Overall, our results support the use of VAP prevention bundle in clinical practice.
Ventilator-associated Pneumonia
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Background: Patients undergoing mechanical ventilation are exposed to the risk of ventilator-associated pneumonia (VAP). Frequent ventilator circuit changes are expensive and unnecessary. We investigated whether extending ventilator circuit intervals from twice weekly to once weekly would impact VAP rates at our hospital.
Methods: Prospective 2-year review of mechanically ventilated adult patients in the medical ICU, respiratory ICU, and general ward at Changhua Christian Hospital. The patients whose ventilator circuits were changed twice a week (at 3- or 4-days intervals) from January 1999 to June 1999 comprised the control group; those whose ventilator circuits were changed once a week from January 2000 to June 2000 formed the study group. There were 210 patients in the control group and 340 patients in the study group receiving mechanical ventilation. Ventilator-related pneumonia was diagnosed based on the criteria of the United States Centers for Disease Control (CDC). The incidence of VAP was determined in both groups.
Results: In the control group, 20 patients developed VAP within 3,372 ventilator days, resulting in a rate of 5.93 per 1000 ventilator days. In the study group, 20 cases of VAP in 5,035 ventilator days resulted in a pneumonia rate of 3.97 per 1000 ventilator days. The difference between the groups was not statistically significant (relative risk 1.51; 95% confidence interval 0.81-2.80; p=0.196).
Conclusions: Extending the intervals between ventilator circuit changes from twice a week to once a week does not increase the risk for VAP.
Ventilator-associated Pneumonia
Mechanical ventilator
Artificial ventilation
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Objective To explore the clinical effect of evidence-based nursing in ventilator-associated pneumonia (VAP).Methods One hundred and sixty patients with mechanical ventilation in our ICU from January 2011 to June 2013 were randomly divided into the observation group and the control group.The control group received the traditional nursing,and the observation group received evidence-based nursing on the basis of the routine nursing.The time of invasive ventilation,the duration of ventilation,the off-line time,the occurrence time of VAP,and the incidence and mortality rates of VAP were compared between two groups.Results The time of invasive ventilation,the duration of ventilation,the off-line time,the occurrence time of VAP in the observation group were respectively (3.3 ± 0.6),(10.3 ± 3.8),(2.6 ± 4.3),(9.2 ± 2.8) d,and were significantly lower or later than (5.6 ± 3.1),(13.1 ± 3.4),(6.5 ± 4.8),(4.8 ± 2.7) d in the control group,and the differences were statistically significant (t =2.58,2.63,2.86,2.79,respectively; P ＜0.05).The incidence and mortality rates of VAP in the observation group were respectively 16.9％ and 10.4％,and were significantly lower than 48.1％ and 34.9％ in the control group,and the differences were statistically significant (x2 =5.36,4.93,respectively; P ＜ 0.01).Conclusions Evidence-based nursing can significantly shorten the time of invasive ventilation,the duration of ventilation and the off-line time; and can also effectively delay and reduce the occurrence of VAP.
Key words:
Ventilator-associated pneumonia; Mechanical ventilation; Evidence-based nursing
Ventilator-associated Pneumonia
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Ventilator-associated Pneumonia
Stenotrophomonas maltophilia
Acinetobacter baumannii
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Ventilator-associated Pneumonia
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BackgroundThat ventilator-associated pneumonia (VAP) can be reduced by continuous and/or intermittent subglottic suction highlights the importance of clearance of oropharyngeal secretions. We prospectively evaluated the usefulness of intermittent suction of oral secretions before each positional change in reducing VAP.MethodsA time-sequence nonrandomized intervention design was used. The study consisted of a 9-month observation phase (control group, 237 patients), a 6-month education phase, followed by a 7-month intervention phase (studied group, 227 patients). The occurrence of VAP, duration of mechanical ventilation, length of intensive care unit (ICU) stay, and mortality were recorded.ResultsVAP occurred less frequently in the studied group (6 of 227 patients, 2.6%) than in the control group (26 of 237 patients, 11.0%; P < 0.001). The incidence rate of VAP in control and studied groups was 6.51 and 2.04 per 1000 ventilator days, respectively (P=0.002). For VAP patients, the ventilator days were 28.8 ± 17.2days and 20.2 ± 4.0days (P=0.009), respectively, and the length of ICU stay was 27.6 ± 17.0days and 20.3 ± 4.0days (P=0.012), respectively, in the control and studied groups. Intermittent suction of oral secretions before each positional change was the only independent factor responsible for a decrease of VAP in the studied group after stepwise logistic regression analysis (P=0.003).ConclusionsIntermittent suction of oral secretions before each positional change may reduce VAP occurrence in ICU patients.
Ventilator-associated Pneumonia
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