Background: Care bundles for ventilator-associated pneumonia (VAP) have been shown to minimize 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 bundles 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 intermittent 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 occurrence 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 neurosurgical patients. It requires low budget and manpower and can be employed in resource-constrained settings.
Stroke is the third leading cause of morbidity and mortality in Thailand accounting for a significant and increasing share of hospital costs. The purpose of this project is to study the epidemiology of the prevalence and its predicting factors of working aged hemorrhagic stroke (HS) patients admitted at a tertiary teaching hospital in Chiang Mai, Thailand.We conducted a five-year retrospective descriptive study. The subjects in this study were patients diagnosed with HS, between 15-59 years of age, and admitted to a tertiary teaching hospital in Chiang Mai, Thailand from January 2009 to December 2013. A total of 404 working aged adults who had HS were admitted to the hospital during this review period; 60.9% males and 39.1% females. Nearly 70% of patients were between 46-59 years of age (M = 47.5, SD = 9.8). Of the patients admitted to the hospital, 76.7% were transferred there from other hospitals. Intracerebral hemorrhage was present in 59.7% of patients. Severe HS occurred in 35.9% of the patients with a Glasgow Coma Score from 3-8. Approximately 69% of the working aged HS patients required surgery. The top five identified risk factors for HS were hypertension (83.4%), hyperlipidemia (38.9%), alcohol consumption (21.5%), smoking (15.3 %), and drug non-adherence (14.9%).We found significantly associated risk factors in working-aged HS by multivariate analysis among male gender (p < .001), drug non-adherence (p = .047), and hypertension (p = .048). Raising awareness to reduce risk behavior and health promotion in the community are the keynotes for health care providers in working-aged HS prevention.
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