Prevention of Intensive Care Unit-Acquired Pneumonia

Abstract

Intensive care unit (ICU) acquired pneumonia is one of the most common and morbid health care-associated infections. Despite decades of work developing and testing prevention strategies, ICU-acquired pneumonia remains stubbornly pervasive. Pneumonia prevention studies are difficult to interpret because all are at risk of bias due to the subjectivity and poor specificity of pneumonia definitions. Interventions associated with improvements in objective outcomes in addition to pneumonia, such as length of stay or mortality, should therefore be prioritized. Avoiding intubation, minimizing sedation, implementing early extubation strategies, and mobilizing patients do appear to improve some of these objective outcomes. Many of our other assumptions about how best to prevent ICU-acquired pneumonia, however, have recently been challenged. Elevating the head of the bed is supported by very little randomized trial data. Early reports suggested that subglottic secretion drainage may decrease time to extubation and ICU length of stay, but more recent analyses refute these findings. Novel endotracheal tube cuff designs do not clearly lower pneumonia rates. A large randomized trial of selective digestive decontamination in ICUs with high baseline rates of antimicrobial resistance did not identify any benefit. Oral care with chlorhexidine may increase mortality risk and stress ulcer prophylaxis may facilitate pneumonia. Early data on probiotics suggest a possible effect but there is no clear signal yet that they shorten duration of mechanical ventilation or lower mortality. Ventilator bundles on balance do appear to be beneficial but it is not clear which components are most important nor how best to implement them. This article will review recent studies that have challenged, refined, or complicated our understanding of how best to prevent ICU-acquired pneumonia.

Nursing in Intensive Care Unit: Exploring Factors Related to Ventilator-Associated Pneumonia

“…Recent studies also con rmed the effectiveness of the VAP prophylaxis package [14,15] . We found that most of these measures were related to nursing [16] .Our survey found that nurse sta ng and nursing practices affect the incidence of ventilator-associated pneumonia ( Table 5). The ndings are that the incidence of VAP had a positive relationship with the proportion of nurses who had worked less than 5 years and the number of patients that nurses care for on the night shift.…”

Impactos da higiene bucal de pacientes em terapia intensiva sobre pneumonias nosocomiais e associadas à ventilação mecânica: revisão integrativa da literatura

“…Registro identificado no banco de dados de busca (Pubmed (pneumonia) AND (oral health)) AND (dental biofilm)) AND (intensive care unit) -n = 3 (1) Klompas, 2019 Seminars in Respiratory and Critical Care Medicine…”

Oral Health In Patients With COVID-19: A Literature Review

“…To prevent these complications, oral care with chlorhexidine have been used. However, a recent systematic review concluded that it is best, for now, to avoid using chlorhexidine in this case given the absence of clear evidence of benefit and the possible suggestion of harm (potentiate the development of intensive care unit-acquired pneumonia) [43].…”