Prevention of Ventilator-Associated Pneumonia in Adults Hospitalized in Intensive Care Units: An Integrative Review
Keywords:
Neumonía asociada a ventilación mecánica, Unidad de Cuidado Intensivos, Estrategias preventivasAbstract
Introduction: Ventilator-associated pneumonia is an important topic due to the growing interest in evaluating the effectiveness of functional, mechanical, and pharmacological interventions for its prevention. However, significant limitations persist in the clinical evidence.
Objective: To identify prevention strategies for ventilator-associated pneumonia in hospitalized adults in intensive care units.
Methods: An integrative review was conducted following PRISMA guidelines. The search was carried out in PubMed, Scopus, and SciELO databases, including studies up to December 2023. Cochrane review criteria were applied, considering population (P), intervention (I), and study design (D). Medical Subject Headings (MeSH) were also used to increase search accuracy. Inclusion criteria encompassed studies on adult patients undergoing mechanical ventilation in intensive care units that evaluated prevention strategies through randomized clinical trials or observational studies. Studies lacking prevention strategies, components, or relevant data were excluded. After selection and evaluation, 12 studies were included, and key data were extracted from each: authors, country, design, and main findings.
Conclusions: Effective strategies include head-of-bed elevation, subglottic drainage, oral hygiene with chlorhexidine, and sedation control. Their implementation within care bundles enhances prevention and supports clinical decision-making in intensive care management.
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American Thoracic S, Infectious Diseases Society of A. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4). https://www.ncbi.nlm.nih.gov/pubmed/15699079
Bonell A, Azarrafiy R, Huong VTL, Viet TL, Phu VD, Dat VQ, et al. A Systematic Review and Meta-analysis of Ventilator-associated Pneumonia in Adults in Asia: An Analysis of National Income Level on Incidence and Etiology. Clin Infect Dis. 2019;68(3):511-8. https://www.ncbi.nlm.nih.gov/pubmed/29982303
Mumtaz H, Saqib M, Khan W, Ismail SM, Sohail H, Muneeb M, et al. Ventilator associated pneumonia in intensive care unit patients: a systematic review. Ann Med Surg (Lond). 2023;85(6):2932-9. https://10.1097/MS9.0000000000000836
Rosenthal VD, Al-Abdely HM, El-Kholy AA, AlKhawaja SAA, Leblebicioglu H, Mehta Y, et al. International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module. Am J Infect Control. 2016;44(12):1495-504. https://10.1016/j.ajic.2016.08.007
Zimlichman E, Henderson D, Tamir O, Franz C, Song P, Yamin CK, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med. 2013;173(22):2039-46. https://10.1001/jamainternmed.2013.9763
Adukauskiene D, Ciginskiene A, Adukauskaite A, Koulenti D, Rello J. Clinical Features and Outcomes of VAP Due to Multidrug-Resistant Klebsiella spp.: A Retrospective Study Comparing Monobacterial and Polybacterial Episodes. Antibiotics (Basel). 2023;12(6). https://10.3390/antibiotics12061056
Fanning J, Panigada M, Li Bassi G. Nosocomial Pneumonia in the Mechanically Ventilated Patient. Semin Respir Crit Care Med. 2022;43(3):426-39. https://10.1055/s-0042-1749448
Ferreira-Coimbra J, Ardanuy C, Diaz E, Leone M, De Pascale G, Povoa P, et al. Ventilator-associated pneumonia diagnosis: a prioritization exercise based on multi-criteria decision analysis. Eur J Clin Microbiol Infect Dis. 2020;39(2):281-6. https://www.ncbi.nlm.nih.gov/pubmed/31654147
Garnacho-Montero J, Corcia-Palomo Y, Amaya-Villar R, Martin-Villen L. How to treat VAP due to MDR pathogens in ICU patients. BMC Infect Dis. 2014;14:135.
Sarda C, Fazal F, Rello J. Management of ventilator-associated pneumonia (VAP) caused by resistant gram-negative bacteria: which is the best strategy to treat? Expert Rev Respir Med. 2019;13(8):787-98.https://www.ncbi.nlm.nih.gov/pubmed/25430700
Isac C, Samson HR, John A. Prevention of VAP: Endless evolving evidences-systematic literature review. Nurs Forum. 2021;56(4):905-15. https://www.ncbi.nlm.nih.gov/pubmed/34091899
Mastrogianni M, Katsoulas T, Galanis P, Korompeli A, Myrianthefs P. The Impact of Care Bundles on Ventilator-Associated Pneumonia (VAP) Prevention in Adult ICUs: A Systematic Review. Antibiotics (Basel). 2023;12(2). https://www.ncbi.nlm.nih.gov/pubmed/36830138
Yin Y, Sun M, Li Z, Bu J, Chen Y, Zhang K, et al. Exploring the Nursing Factors Related to Ventilator-Associated Pneumonia in the Intensive Care Unit. Front Public Health. 2022;10:715566. https://www.ncbi.nlm.nih.gov/pubmed/35462831
Darawad MW, Sa'aleek MA, Shawashi T. Evidence-based guidelines for prevention of ventilator-associated pneumonia: Evaluation of intensive care unit nurses' adherence. Am J Infect Control. 2018;46(6):711-3. https://www.ncbi.nlm.nih.gov/pubmed/29305283
Keyt H, Faverio P, Restrepo MI. Prevention of ventilator-associated pneumonia in the intensive care unit: a review of the clinically relevant recent advancements. Indian J Med Res. 2014;139(6):814-21. https://www.ncbi.nlm.nih.gov/pubmed/25109715
Coelho L, Moniz P, Guerreiro G, Povoa P. Airway and Respiratory Devices in the Prevention of Ventilator-Associated Pneumonia. Medicina (Kaunas). 2023;59(2). https://www.ncbi.nlm.nih.gov/pubmed/36837404
Thapa D, Liu T, Chair SY. Multifaceted interventions are likely to be more effective to increase adherence to the ventilator care bundle: A systematic review of strategies to improve care bundle compliance. Intensive Crit Care Nurs. 2023;74:103310. https://www.ncbi.nlm.nih.gov/pubmed/36154789
Kallet RH. Ventilator Bundles in Transition: From Prevention of Ventilator-Associated Pneumonia to Prevention of Ventilator-Associated Events. Respir Care. 2019;64(8):994-1006. https://www.ncbi.nlm.nih.gov/pubmed/31346074
Alecrim RX, Taminato M, Belasco A, Longo MCB, Kusahara DM, Fram D. Strategies for preventing ventilator-associated pneumonia: an integrative review. Rev Bras Enferm. 2019;72(2):521-30.https://www.ncbi.nlm.nih.gov/pubmed/31017218
Chahoud J, Semaan A, Almoosa KF. Ventilator-associated events prevention, learning lessons from the past: A systematic review. Heart Lung. 2015;44(3):251-9. https://www.ncbi.nlm.nih.gov/pubmed/25686517
Mao Z, Gao L, Wang G, Liu C, Zhao Y, Gu W, et al. Subglottic secretion suction for preventing ventilator-associated pneumonia: an updated meta-analysis and trial sequential analysis. Crit Care. 2016;20(1):353. https://www.ncbi.nlm.nih.gov/pubmed/27788682
Rabello F, Araújo V, Magalhães S. Effectiveness of oral chlorhexidine for the prevention of nosocomial pneumonia and ventilator-associated pneumonia in intensive care units: Overview of systematic reviews. International Journal of Dental Hygiene. 2018;16(4):441-9. https://doi.org/10.1111/idh.12336
Martinez-Reviejo R, Tejada S, Jansson M, Ruiz-Spinelli A, Ramirez-Estrada S, Ege D, et al. Prevention of ventilator-associated pneumonia through care bundles: A systematic review and meta-analysis. Journal of Intensive Medicine. 2023;3(4):352-64. https://doi.org/10.1016/j.jointm.2023.04.004
Mahmoodpoor A, Sanaie S, Parthvi R, Shadvar K, Hamishekar H, Iranpour A, et al. A clinical trial of silver-coated and tapered cuff plus supraglottic suctioning endotracheal tubes in preventing ventilator-associated pneumonia. J Crit Care. 2020;56:171-6. https://www.ncbi.nlm.nih.gov/pubmed/31935605
Kes D, Aydin Yildirim T, Kuru C, Pazarlioglu F, Ciftci T, Ozdemir M. Effect of 0.12% Chlorhexidine Use for Oral Care on Ventilator-Associated Respiratory Infections: A Randomized Controlled Trial. J Trauma Nurs. 2021;28(4):228-34. https://www.ncbi.nlm.nih.gov/pubmed/34210941
Viana WN, Bragazzi C, Couto de Castro JE, Alves MB, Rocco JR. Ventilator-associated pneumonia prevention by education and two combined bedside strategies. Int J Qual Health Care. 2013;25(3):308-13. https://www.ncbi.nlm.nih.gov/pubmed/23537916
Tincu RC, Cobilinschi C, Tincu IF, Macovei RA. Efficacy of Noble Metal-alloy Endotracheal Tubes in Ventilator-associated Pneumonia Prevention: a Randomized Clinical Trial. Balkan Med J. 2022;39(3):167-71. https://www.ncbi.nlm.nih.gov/pubmed/35332771
Staudinger T, Bojic A, Holzinger U, Meyer B, Rohwer M, Mallner F, et al. Continuous lateral rotation therapy to prevent ventilator-associated pneumonia. Crit Care Med. 2010;38(2):486-90. https://www.ncbi.nlm.nih.gov/pubmed/19789440
Akdogan O, Ersoy Y, Kuzucu C, Gedik E, Togal T, Yetkin F. Assessment of the effectiveness of a ventilator associated pneumonia prevention bundle that contains endotracheal tube with subglottic drainage and cuff pressure monitorization. Braz J Infect Dis. 2017;21(3):276-81. https://www.ncbi.nlm.nih.gov/pubmed/28193455
Ehrmann S, Barbier F, Demiselle J, Quenot JP, Herbrecht JE, Roux D, et al. Inhaled Amikacin to Prevent Ventilator-Associated Pneumonia. N Engl J Med. 2023;389(22):2052-62. https://www.ncbi.nlm.nih.gov/pubmed/37888914
Chacko R, Rajan A, Lionel P, Thilagavathi M, Yadav B, Premkumar J. Oral decontamination techniques and ventilator-associated pneumonia. Br J Nurs. 2017;26(11):594-9. https://www.ncbi.nlm.nih.gov/pubmed/28594615
Johnstone J, Meade M, Lauzier F, Marshall J, Duan E, Dionne J, et al. Effect of Probiotics on Incident Ventilator-Associated Pneumonia in Critically Ill Patients: A Randomized Clinical Trial. JAMA. 2021;326(11):1024-33. https://www.ncbi.nlm.nih.gov/pubmed/34546300
Guner CK, Kutluturkan S. Role of head-of-bed elevation in preventing ventilator-associated pneumonia bed elevation and pneumonia. Nurs Crit Care. 2022;27(5):635-45. https://www.ncbi.nlm.nih.gov/pubmed/33884691
Chaari A, Zribi E, Dammak H, Ghadoun H, Chtara K, Sfar S, et al. Does selective digestive decontamination prevent ventilator-associated pneumonia in trauma patients? Am J Ther. 2014;21(6):470-6. https://www.ncbi.nlm.nih.gov/pubmed/23567785
Alvarez-Lerma F, Palomar-Martinez M, Sanchez-Garcia M, Martinez-Alonso M, Alvarez-Rodriguez J, Lorente L, et al. Prevention of Ventilator-Associated Pneumonia: The Multimodal Approach of the Spanish ICU "Pneumonia Zero" Program. Crit Care Med. 2018;46(2):181-8. https://www.ncbi.nlm.nih.gov/pubmed/29023261
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