Clinical epidemiology and outcomes of ventilator-associated pneumonia in critically ill adult patients: protocol for a large-scale systematic review and planned meta-analysis

Abstract

Background An increasing number of studies have investigated the clinical epidemiology and outcomes of ventilator-associated pneumonia (VAP) in intensive care units. However, these findings have not been clearly defined in broad subgroups of mechanically ventilated adults. Hence, this protocol for a systematic review and meta-analysis is designed to better understand the clinical and epidemiological features of VAP in these patient populations by establishing its overall prognosis of and risk factors for morbidity and mortality and to determine the differences in clinical and economic outcomes between VAP and non-VAP patients. Methods This present review will systematically search available full-text articles without date and language restrictions and indexed in PubMed, CENTRAL, CINAHL, Web of Science, and EMBASE databases. In addition, reference lists and citations of retrieved articles and relevant medical and nursing journals will be manually reviewed. Supplementary search in other databases involving trials, reviews, and grey literatures, including conference proceedings, theses, and dissertations, will be performed. Study investigators will be contacted to clarify missing or unpublished data. All prognostic studies meeting the pre-defined eligibility criteria will be included. The study selection, risk of bias assessment, data extraction, and grading of the quality of evidence will be carried out in duplicate, involving independent evaluation by two investigators with consensus or a third-party adjudication. The degree of inter-rater agreement will be calculated using the kappa statistic. For meta-analysis, dichotomous and continuous outcome measures will be pooled using odds ratios and standardized mean differences with 95% confidence intervals, respectively. The Mantel-Haenszel or inverse variance methods with random effects model will be used as a guide for analysis. The heterogeneity of each outcome measure will be assessed using both X 2 and I 2 statistics. In addition, sensitivity and subgroup analyses will be performed to ensure consistency of pooled results. The review protocol described herein is in accordance with the PRISMA-P standards. Discussion The investigation of the epidemiological profiles, prognostic factors, and outcomes associated with VAP is critical for the identification of high-risk groups of mechanically ventilated patients and evaluation of possible clinical endpoints. This may provide substantial links for improved VAP prevention practices targeting modifiable risk factors. Implications for future research directions are discussed. Systematic review registration PROSPERO CRD42017048158 Electronic supplementary material The online version of this article (10.1186/s13643-019-1080-y) contains supplementary material, which is available to authorized users.

Correlation of ICU Nurses’ Cognitive Level with Their Attitude and Behavior toward the Prevention of Ventilator-Associated Pneumonia

“…Jacobs Pepin et al [19] pointed out that enhancing the cognitive level of ICU nurses was beneficial to improve their attitude and behavior and reduce the occurrence of adverse events, so ICU nurses should pay more attention to the learning of VAP prevention knowledge while maintaining their own attitude and behavior and strive to improve their own cognitive level and reduce the occurrence of unnecessary medical accidents and disputes. As the key role of medical career development, nurses spend the longest time with patients in clinic, and there are more ethical problems in treatment and nursing work, so related training means should be adopted in hospital management to improve ICU nurses' cognitive level, service attitude, and nursing behavior, thus creating a good internal ethical atmosphere in hospitals [20][21][22]. Hospitals can establish an intensive care collaborative network and adopt horizontal training to enable transfer of ICU nurses in relevant ICUs, and the nurses receive short-term and effective training to study ICU-related professional English, so that the more mature nursing knowledge and information can be collected, and at the same time, evaluation standards of knowledge and practice for the prevention of VAP are developed to further improve ICU nurses' awareness.…”

Effect of clove mouthwash on the incidence of ventilator-associated pneumonia in intensive care unit patients: a comparative randomized triple-blind clinical trial

“…MV is performed to maintain open airways, prevent aspiration, and increase oxygenation. These supportive interventions are essential to critical care and are regarded as the benchmarks for managing the airways and ventilation [3]. One of the most common side effects of MV is ventilator-associated pneumonia (VAP), which is among the most frequently occurring nosocomial infections and accounts for 25% of ICU-acquired infections [4,5].…”

The effect of ventilator-associated pneumonia on the prognosis of intensive care unit patients within 90 days and 180 days

“…Mechanical ventilation (MV) is often applied in critically ill patients in intensive care unit (ICU) [ 1 ]. MV may result in various complications and bring substantial risks in ICU patients [ 2 ].…”