Evidence-Based Clinical Practice Guideline for the Prevention of Ventilator-Associated Pneumonia

Dodek, Peter; Keenan, Sean; Cook, Deborah J.; Heyland, Daren K.; Jacka, Michael J.; Hand, Lori; Muscedere, John; Foster, Debra; Mehta, Nav; Hall, Richard; Brun‐Buisson, Christian

doi:10.7326/0003-4819-141-4-200408170-00011

Cited by 442 publications

(259 citation statements)

References 96 publications

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“…By focusing solely on VAP, nurses can miss out on preventing other respiratory infections that have similar outcomes. Costs associated with development of pulmonary infections in our study were similar to those reported by researchers [29][30][31][32] who evaluated the costs of VAP in patients as a whole treated with mechanical ventilation and reported up to $40 000 in attributable costs.…”

Section: Discussionsupporting

confidence: 77%

Comparison of Respiratory Infections before and after Percutaneous Tracheostomy

Sole

Talbert

Penoyer

et al. 2014

American Journal of Critical Care

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Background A tracheostomy is often performed when patients cannot be weaned from mechanical ventilation. Respiratory infections (ventilator-associated pneumonia and infection of the lower respiratory tract) complicate the course of hospitalization in patients receiving mechanical ventilation. Objectives To evaluate respiratory infections before and after a percutaneous tracheostomy and to describe their outcomes. Methods Medical records of adults who had percutaneous tracheostomy during a 1-year period at a tertiary care hospital in the southeastern United States were reviewed retrospectively. Results Data for 322 patients were analyzed. Patients were predominately male (63.0%) and white (57.8%), with a mean age of 57.4 years. Ventilator-associated pneumonia or infection of the lower respiratory tract was identified in 90 patients (28.0%); the majority of infections were lower respiratory infections. Of all infections, 52% occurred before the tracheostomy, and 48% occurred after the procedure. Respiratory infections were associated with longer stays and higher costs, which were significantly higher in patients in whom the infection developed after the tracheostomy. Gram-negative organisms were responsible for the majority of infections. Conclusions Data related to respiratory infections that occurred before a tracheostomy were similar to data related to infections that occurred after a tracheostomy. Most infections were classified as lower respiratory infection rather than pneumonia. Infection, before or after a tracheostomy, resulted in longer stays and higher costs for care. Interventions focused on preventing infection before and after tracheostomy are warranted.

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Section: Discussionsupporting

confidence: 77%

Comparison of Respiratory Infections before and after Percutaneous Tracheostomy

Sole

Talbert

Penoyer

et al. 2014

American Journal of Critical Care

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“…Reducing the acidity of gastric secretions and feeding will reduce bacterial overgrowth. However, in high-risk patients (ventilated for Ͼ48 h and coagulopathic), the risk of bleeding outweighs the risk of VAP from pH-modifying agents (52). Hence, it is difficult to recommend against H 2 blockers or proton pump inhibitors.…”

Section: Preventionmentioning

confidence: 99%

“…In theory the closed system could reduce the incidence of VAP, but in practice this has not been demonstrated (35,50,93,106,219). Cost analysis favors the closed system, as the enveloped catheter can be reused for suctioning and needs to be changed only when dysfunctional (52). However, respiratory therapists have voiced concerns over residue buildup within the lumen of the endotracheal tube.…”

Section: Preventionmentioning

confidence: 99%

Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention

2006

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SUMMARY While critically ill patients experience a life-threatening illness, they commonly contract ventilator-associated pneumonia. This nosocomial infection increases morbidity and likely mortality as well as the cost of health care. This article reviews the literature with regard to diagnosis, treatment, and prevention. It provides conclusions that can be implemented in practice as well as an algorithm for the bedside clinician and also focuses on the controversies with regard to diagnostic tools and approaches, treatment plans, and prevention strategies.

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“…15 In addition, the simple practice of elevating the head of the bed greater than 30º can decrease the risk of VAP. 16 Nurses learned that SCIP is a partnership of organizations that focus on reducing surgical complications and improving surgical care and they learned what components are included in the SCIP bundle. Finally, the importance of completing all measures in the bundles was stressed.…”

Section: Educationmentioning

confidence: 99%