Pre‐intensive care unit intubation and subsequent delayed intensive care unit admission is independently associated with increased occurrence of ventilator‐associated pneumonia

Tsakiridou, Eirini; Mega, A; Zakynthinos, Εpameinondas; Melissopoulou, Theodora; Stamos, G.; Argyriou, Konstantinos; Pangrati, Stamatoula; Deliolanis, Ioannis; Floros, Ioannis

doi:10.1111/crj.12944

Cited by 8 publications

(8 citation statements)

References 26 publications

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“…One study had multinational design [ 10 ], and nine studies had multicenter design [ 1 , 12 , 25 , 27 , 28 , 32 , 37 , 40 , 43 ], while the other studies had single-center design. Eleven studies used prospective data collection [ 10 , 13 , 25 , 26 , 31 , 37 – 39 , 41 , 42 , 44 ], and one study used both prospective and retrospective data collection [ 9 ], while the other studies used retrospective data collection. According to the NOS score ≥ 6, risk for bias was low in all included studies, while according to the additional criteria used, risk for bias was ≤3 in 20 studies.…”

Section: Resultsmentioning

confidence: 99%

“…In total, unadjusted mortality was significantly higher in the delayed ICU admission group compared to the nondelayed group in 22 studies, specifically hospital mortality in 18 studies [ 1 , 6 , 9 , 12 , 14 , 24 , 28 – 32 , 35 , 36 , 39 , 40 , 43 – 45 ], ICU mortality in nine studies [ 1 , 9 , 12 , 13 , 26 , 27 , 31 , 35 , 40 ], 30-day mortality in two studies [ 12 , 17 ], and 60-day and 90-day mortality in one study each [ 6 , 17 ]. In 11 studies [ 2 , 10 , 11 , 23 , 33 , 34 , 37 , 38 , 41 , 42 , 46 ], no significant differences in unadjusted mortality were detected between the delayed and nondelayed ICU admission groups.…”

Section: Resultsmentioning

confidence: 99%

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Delayed Admission to the Intensive Care Unit and Mortality of Critically Ill Adults: Systematic Review and Meta-analysis

Kiekkas

Tzenalis

Gklava

et al. 2022

BioMed Research International

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Delayed admission of patients to the intensive care unit (ICU) is increasing worldwide and can be followed by adverse outcomes when critical care treatment is not provided timely. This systematic review and meta-analysis appraised and synthesized the published literature about the association between delayed ICU admission and mortality of adult patients. Articles published from inception up to August 2021 in English-language, peer-reviewed journals indexed in CINAHL, PubMed, Scopus, Cochrane Library, and Web of Science were searched by using key terms. Delayed ICU admission constituted the intervention, while mortality for any predefined time period was the outcome. Risk for bias was evaluated with the Newcastle-Ottawa Scale and additional criteria. Study findings were synthesized qualitatively, while the odds ratios (ORs) for mortality with 95% confidence intervals (CIs) were combined quantitatively. Thirty-four observational studies met inclusion criteria. Risk for bias was low in most studies. Unadjusted mortality was reported in 33 studies and was significantly higher in the delayed ICU admission group in 23 studies. Adjusted mortality was reported in 18 studies, and delayed ICU admission was independently associated with significantly higher mortality in 13 studies. Overall, pooled OR for mortality in case of delayed ICU admission was 1.61 (95% CI 1.44-1.81). Interstudy heterogeneity was high ( I 2 = 66.96 % ). According to subgroup analysis, OR for mortality was remarkably higher in postoperative patients (OR, 2.44, 95% CI 1.49-4.01). These findings indicate that delayed ICU admission is significantly associated with mortality of critically ill adults and highlight the importance of providing timely critical care in non-ICU settings.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Delayed Admission to the Intensive Care Unit and Mortality of Critically Ill Adults: Systematic Review and Meta-analysis

Kiekkas

Tzenalis

Gklava

et al. 2022

BioMed Research International

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“…Considering the pre and post-intervention periods, we found that adherence to cuff pressure check increased by 8.10% (Table 1), being cited by 60% of physiotherapists and 33% of nursing technicians (Table 2). The cuff pressure measurement verifies the pressure value that should be high enough to avoid leakage that would make mechanical MV ineffective, thus preventing the progression of secretions from the oropharynx to the lower airways (4)(5)(6)(7)(8)(9)(10)(11)(12) .…”

Section: Discussionmentioning

confidence: 99%

“…The Institute for Healthcare Improvement (IHI) introduced in 2004 the notion of bundle for the prevention of VAP. The bundle consists of a set of interventions based on scientific evidence that, when implemented, may improve health outcomes and patient care 5 . Since its implementation, there has been a decline in VAP rates in the United States, with 3.6 cases per 1000 days in the ventilator 6 .…”

Section: Introductionmentioning

confidence: 99%

O Impacto Da Aprendizagem Interprofissional Na Pneumonia Associada À Ventilação: Implementação De Bundles Em Uma Unidade De Cuidados Intensivos

Coelho

Vieira²,

Leite³

et al. 2020

revenf

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Objetivo: verificar o impacto dos bundles e o aprendizado interprofissional na prevenção de pneumonia associada à ventilação mecânica de uma unidade de terapia intensiva (UTI). Método: estudo quasi-experimental realizado em uma UTI de um hospital público de Diamantina, Minas Gerais. Foram incluídos neste estudo 56 profissionais que prestavam assistência direta a pacientes em ventilação mecânica. A coleta de dados ocorreu em três fases: pré-intervenção, que consistiu em observação direta e entrevista; intervenção, na qual o treinamento foi realizado por meio de simulações clínicas; e pós-intervenção, na qual foi avaliado o impacto das estratégias implementadas por observação direta. As diferenças entre os grupos pré- e pós-intervenção foram avaliadas pelo teste de McNemar. Foi utilizado um nível alfa de 0,05 definido a priori, e a correção de Bonferroni determinou significância estatística para o caso de comparações múltiplas. Resultados: após a intervenção, houve aumento da adesão à pressão endotraqueal do cuff (8,10%), interrupção diária da sedação (16,67%), e aspiração subglótica (18,75%). As associações entre categoria profissional versus ausência de aspiração, posicionamento da cabeceira da cama, frequência de higiene bucal, e tipo de higiene das mãos após a intervenção foram significativas (p < 0,0083). Conclusões: ainda existe uma lacuna a ser detectada na implementação do bundle e o impacto positivo gerado pelo conhecimento interprofissional, principalmente porque não é imediato, mas a longo prazo, para obter o feedback desejado.Palavras-chave: Pneumonia Associada a Ventilação; Bundles de Assistência ao Paciente; Controle de infecção; Melhoria da qualidade; Vigilância em saúde pública; Unidades de Terapia Intensiva.THE IMPACT OF THE INTERPROFESSIONAL LEARNING IN VENTILATOR-ASSOCIATED PNEUMONIA: BUNDLES IMPLEMENTATION IN AN INTENSIVE CARE UNITObjective: to verify the impact of the bundles and the interprofessional learning for the prevention of mechanical ventilation-associated pneumonia of an intensive care unit (ICU). Method: This was a quasi-experimental study performed in an ICU of a public hospital in Diamantina, Minas Gerais. Were included in this study 56 professionals who provided direct assistance to patients in mechanical ventilation. The data collection took place in three phases: pre-intervention, which consisted of direct observation and interview; intervention, in which training was performed through clinical simulations; and post-intervention, in which the impact of the strategies implemented through direct observation, was evaluated. Differences between pre and post groups were assessed using McNemar’s test. An alpha level of 0.05 set a priori was used, and a Bonferroni correction determined statistical significance for the case of multiple comparisons. Results: After the intervention, there was increased adherence to endotracheal cuff pressure (8.10%), daily interruption of sedation (16.67%) and subglottic aspiration (18.75%). It was significant (p < 0,0083) in the associations between the professional category versus non-aspiration, bed head positioning, oral hygiene frequency and the type of hand hygiene after intervention. Conclusions: There is still a gap to be detected in the bundle implementation and the positive impact generated by the inter-professional knowledge, mainly because it is not immediate but in the long term to obtain the desired feedback.Keywords: Pneumonia, Ventilator-Associated; Patient Care Bundles; Infection Control; Quality Improvement; Public health surveillance; Intensive Care Units.EL IMPACTO DEL APRENDIZAJE INTERPROFESIONAL EN LA NEUMONÍA ASOCIADA A VENTILADORES: APLICACIÓN DE PAQUETES EN UNA UNIDAD DE ATENCIÓN INTENSIVAObjetivo: verificar el impacto de los bundles y el aprendizaje interprofesional para la prevención de la neumonía asociada a la ventilación mecánica de una unidad de cuidados intensivos (UCI). Método: Este fue un estudio cuasi experimental realizado en una UCI de un hospital público en Diamantina, Minas Gerais. Se incluyeron en este estudio 56 profesionales que prestaron asistencia directa a los pacientes en ventilación mecánica. La recolección de datos se realizó en tres fases: pre-intervención, que consistió en observación directa y entrevista; intervención, en la cual se realizó entrenamiento por medio de simulaciones clínicas; y post-intervención, en que se evaluó el impacto de las estrategias de observación directa. Las diferencias entre los grupos pre y post se evaluaron mediante la prueba de McNemar. Se usó un nivel alfa de 0,05 a priori, y se usó una corrección de Bonferroni para determinar la significación estadística en el caso de comparaciones múltiples. Resultados: Después de la intervención, hubo aumento de la adhesión al monitoreo de la presión del cuff endotraqueal (8,10%), interrupción diaria de la sedación (16,67%) y aspiración subglótica (18,75%). Fue significativa (p < 0,0083) las asociaciones entre la categoría profesional frente a la no aspiración, la posición de la cabecera de la cama, la frecuencia de higiene oral y el tipo de higiene de las manos después de la intervención. Conclusiones: Aún existe una laguna a ser detectada en la implantación del bundle y el impacto positivo generado por el conocimiento interprofesional, principalmente por no ser inmediato, pero a largo plazo, para obtener el feedback deseado.Descriptores: Neumonía Asociada al Ventilador; Paquetes de Atención al Paciente; Control de Infecciones; Mejoramiento de la Calidad; Vigilancia en Salud Pública; Unidades de Cuidados Intensivos

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“…Es importante tener en cuenta que, si bien el desarrollo de neumonía está relacionado con el tiempo de exposición al tubo orotraqueal, el lugar donde se realiza la intubación puede influir notablemente en el desarrollo de esta patología; en esta investigación la mayor parte de las intubaciones fueron realizadas en urgencias, seguido del quirófano y finalmente UCI. Según lo observado con anterioridad, Tsakiridou et al realizaron una investigación con el propósito de evaluar si la intubación previa al ingreso a UCI se asociaba con NAVM, tras analizar una población de 100 sujetos encontraron que incurrir en esta práctica aumenta la probabilidad de padecer la neumonía (26). Referente a los días de estancia en UCI y en el servicio de hospitalización general no se reportaron diferencias importantes.…”

Section: Discussionunclassified

Traqueostomía Temprana vs Tardía en Pacientes Neuroquirúrgicos Internados en Una Unidad De Cuidados Intensivos.

Mosquera

Builes²,

Cano³

et al. 2020

Enferm. investig.

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Introducción: Los pacientes neurocríticos por lo general requieren periodos largos de ventilación mecánica, en ese contexto la traqueostomía es un procedimiento frecuente que se realiza para facilitar el destete de la ventilación y se asocia a múltiples beneficios; sin embargo, el momento de su realización sigue siendo objeto de debate. Objetivo: determinar los beneficios clínicos de la traqueostomía temprana vs la tardía en los pacientes neurocríticos que ingresan a una unidad de cuidados intensivos (UCI) polivalente de una institución de salud de la ciudad de Cali. Metodología: investigación observacional, descriptiva, de serie de casos que incluyó pacientes neuroquirúrgicos, mayores de edad que ingresaron a una UCI durante el periodo 2016 -2018; a partir de la muestra total se estipularon dos grupos: traqueostomía temprana (≤ 9 días) y traqueostomía tardía (≥10 días). El análisis estadístico se realizó en el programa SPSS versión 24. Resultados: Se incluyeron 20 sujetos con edad de 51.9±17 años, 10 fueron asignados al grupo de traqueostomía temprana y 10 al grupo den traqueostomía tardía. Se evidenció que los pacientes con traqueostomía temprana tienen menos días de sedación (10±2.1 vs 16±9; p=0.02) y los 3 casos que fallecieron habían sido traqueostomizados tardíamente. Conclusiones: La traqueostomía temprana puede traer beneficios clínicos a los pacientes neuroquirúrgicos que ingresan a unidades de cuidados intensivos. Palabras claves: Traqueostomía, unidades de cuidados intensivos, paciente, ventilación mecánica. ABSTRACT Introduction: Neurocritical patients generally require long periods of mechanical ventilation. In this context, tracheostomy is a frequent procedure performed to facilitate weaning from ventilation and is associated with multiple benefits; however, the timing of its implementation remains under debate. Objective: to determine the clinical benefits of early vs late tracheostomy in neurocritical patients admitted to a polyvalent intensive care unit (ICU) of a health institution in the city of Cali. Methodology: observational, descriptive investigation of a series of cases that included neurosurgical patients, of legal age who were admitted to an ICU during the period 2016 -2018; From the total sample, two groups were stipulated: early tracheostomy (≤ 9 days) and late tracheostomy (≥10 days). Statistical analysis was performed using SPSS version 24. Results: 20 subjects with an age of 51.9 ± 17 years were included, 10 were assigned to the early tracheostomy group and 10 to the late tracheostomy group. It was evidenced that patients with early tracheostomy had fewer days of sedation (10±2.1 vs 16± 9; p= 0.02) and the 3 cases that died had been tracheostomized late. Conclusions: Early tracheostomy can bring clinical benefits to neurosurgical patients admitted to intensive care units. Keywords: Tracheostomy, intensive care units, patient, mechanic ventilation.

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Pre‐intensive care unit intubation and subsequent delayed intensive care unit admission is independently associated with increased occurrence of ventilator‐associated pneumonia

Abstract: Pre-ICU intubation and delayed ICU admission was independent risk factor for VAP Acinetobacter baumannii infection and a high SOFA score on ICU admission were predictors of increased ICU mortality.

Cited by 8 publications

References 26 publications

Delayed Admission to the Intensive Care Unit and Mortality of Critically Ill Adults: Systematic Review and Meta-analysis

Delayed Admission to the Intensive Care Unit and Mortality of Critically Ill Adults: Systematic Review and Meta-analysis

O Impacto Da Aprendizagem Interprofissional Na Pneumonia Associada À Ventilação: Implementação De Bundles Em Uma Unidade De Cuidados Intensivos

Traqueostomía Temprana vs Tardía en Pacientes Neuroquirúrgicos Internados en Una Unidad De Cuidados Intensivos.

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