Evaluating the Impact of Pneumonia Prevention Recommendations After Cardiac Surgery

Abstract

Background. Pneumonia is the most prevalent healthcareassociated infection after coronary artery bypass grafting (CABG), but the relative effectiveness of strategies to reduce its incidence remains unclear. We evaluated the relationship between healthcare-associated infection recommendations and risk of pneumonia after CABG.Methods. Pneumonia prevention practice recommendations were developed based on literature review and analysis of semistructured interviews with key health care personnel across centers with low (<5.9%), medium (5.9%-6.1%), and high (>6.1%) rates of pneumonia. These practices were implemented among 2482 patients undergoing CABG from 2016 to 2017 across 18 centers. The independent effect of each practice in reducing pneumonia was assessed using multivariable logistic regression, adjusting for baseline risk and center. A composite (bundle) score was calculated as the number of practices (0 to 4) each patient received.Results. Recommended pneumonia prevention practices included lung protective ventilation management, early extubation, progressive ambulation, and avoidance of postoperative bronchodilator therapy. Pneumonia occurred in 2.4% of patients. Lung protective ventilation (adjusted odds ratio [OR adj ], 0.45; 95% confidence interval [CI], 0.22-0.92), ambulation (OR adj , 0.08; 95% CI, 0.04-0.17), and postoperative ventilation of less than 6 hours (OR adj , 0.47; 95% CI, 0.26-0.87) were significantly associated with lower odds of pneumonia. Postoperative bronchodilator therapy (OR adj , 4.83; 95% CI, 2.20-10.7) was significantly associated with higher odds. Risk-adjusted rates of pneumonia, operative mortality, and intensive care unit length of stay were lower in patients with higher bundle scores (all P-trend < .01).Conclusions. These pneumonia prevention recommendations may serve as effective targets for avoiding postoperative healthcare-associated infections.

Development and validation of a nomogram model for pneumonia after redo cardiac surgery

“…The association between the increased risk of POP and prolonged mechanical ventilation may be explained by the damage to the defense mechanism of the respiratory system, and preforming extubation as early as possible may be a feasible strategy for reducing POP. [33][34][35] In addition to the prediction of individualized POP risk, the nomogram model may play an important role in risk stratification and clinical prevention. Several preventive measures, such as subglottic secretion drainage and preoperative chlorhexidine mouthwash, may be helpful for the reduction of POP risk.…”

“…Nevertheless, we did not incorporate these factors into our multivariate analysis as they were postoperative variables and were not available early. The association between the increased risk of POP and prolonged mechanical ventilation may be explained by the damage to the defense mechanism of the respiratory system, and preforming extubation as early as possible may be a feasible strategy for reducing POP 33–35 …”

High-Energy Enteral Nutrition in Infants After Complex Congenital Heart Surgery

“…There is a significant correlation between nutritional status and the prognosis of critically ill children ( 24 , 25 ), which was mainly reflected in this study by shorter duration of mechanical ventilation and lower incidence of pneumonia in the intervention group. This is because earlier extubation prevents pneumonia ( 26 ); it is also possible that children with poor nutritional status have a poor inflammatory response and are therefore more susceptible to pneumonia, as other studies have confirmed ( 27 , 28 ). However, the findings on whether high-energy nutrition shortens the length of hospital stay have not been uniform.…”

Pneumonia After Cardiovascular Surgery: Incidence, Risk Factors and Interventions

“…Some other measures have also been reported to be effective in prevention and treatment, including lung protective ventilation management, alveolar recruitment maneuvers, early mobilization and progressive ambulation, elevation of the head end and semi-recumbent positioning, sedation vacation and the use of a weaning protocol, early extubation, strict changes of ventilatory circuit tube, appropriate cuff pressure control, use of non-invasive ventilation, proper use of tracheostomy, enteral feeding, selective digestive decontamination, peptic ulcer disease prophylaxis, silver-coated endotracheal tubes, microbiological surveillance, and deep vein thrombosis prophylaxis (104)(105)(106)(107)(108)(109). In recent years, some prevention care bundles and prevention checklists which consist a series of rationalized measures have been developed and validated to be effective and convenient in preventing POP and shortening the duration of mechanical ventilation.…”