Prevention methods of ventilator-associated pneumonia
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Abstract
Introduction: Ventilator-associated pneumonia (VAP) is one of the most frequent nosocomial infections and generates high morbidity and mortality. Objective: To identify methods for the prevention of VAP in the hospital environment in the literature. Methods: The search was performed in PubMed and the search was based on the descriptors: "Ventilator-associated pneumonia", "ICU" and "infection control" and their respective descriptors in Portuguese, as suggested by the DeCS platform. Results: A total of 114 articles were found, of which 24 were used. Free articles published between 2018-2023, in Portuguese or English, related to the human species were included. Articles without data or relevance to the topic were excluded. Regarding the prevention methods found in the literature, oral hygiene with chlorhexidine and the use of probiotics showed divergence in efficacy and chlorhexidine bathing proved to be ineffective. Oral hygiene with colostrum, baking soda, and blackhead mouthwash showed prophylactic benefits. Lining of the endotracheal tube with noble metals indicated efficacy, also selective decontamination of the digestive tract, hand hygiene, antimicrobial interventions, and VAP prevention packages. These packages encompass more comprehensive measures that are related to the measures with the greatest benefits in the prophylaxis of VAP. Conclusion: Ventilator-associated pneumonia (VAP) is a preventable complication and demonstrates the need for further studies to clarify divergences and increase the repertoire of prevention measures.
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References
AKKOC, G.; et al. Reduction of nosocomial infections in the intensive care unit using an electronic hand hygiene compliance monitoring system. J Infect Dev Ctries, v. 15(12), p. 1923-1928, 2021. DOI: 10.3855/jidc.14156.
AZEVEDO, L.C.P.; et al. Medicina Intensiva: abordagem prática. 5 ed. Santana de Parnaíba [SP] : Manole, 2022.
BRASIL. Agência Nacional de Vigilância Sanitária. Critérios Diagnósticos de Infecções Relacionadas à Assistência à Saúde/Agência Nacional de Vigilância Sanitária. Brasília: Anvisa, 2017. Disponível em: https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/publicacoes/caderno-2-criterios-diagnosticos-de-infeccao-relacionada-a-assistencia-a-saude.pdf/view. Acesso em: 10 jun. 2023.
BRASIL. Agência Nacional de Vigilância Sanitária. Medidas de Prevenção de Infecção Relacionada à Assistência à Saúde. Brasília: Anvisa, 2017. Disponível em: https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/publicacoes/caderno-4-medidas-de-prevencao-de-infeccao-relacionada-a-assistencia-a-saude.pdf/view. Acesso em: 10 jun. 2023.
BUTERAKOS, R.; et al. An in-depth look at ventilator-associated pneumonia in trauma patients and efforts to increase bundle compliance, education and documentation in a surgical trauma critical care unit. Am J Infect Control, v. 50(12), p. 1333-1338. DOI: 10.1016/j.ajic.2022.01.029.
CARVALHO, C.R.R.; TOUFEN JUNIOR, C.; FRANCA, S.A. Ventilação mecânica: princípios, análise gráfica e modalidades ventilatórias. Jornal Brasileiro de Pneumologia, Brasília, v. 33, suplemento 2, p. S54-S70, 2007. DOI: https://doi.org/10.1590/S1806-37132007000800002.
CHEN, R.; et al. Risk Factors and Nursing Countermeasures of Ventilator-Associated Pneumonia in Children in the Intensive Care Unit. J Healthc Eng, v. 2022, 2022. DOI: 10.1155/2022/9055587.
CODRU, I.R.; et al. A Study on the Contributions of Sonication to the Identification of Bacteria Associated with Intubation Cannula Biofilm and the Risk of Ventilator-Associated Pneumonia. Medicina, v. 59(6), 2023. DOI: 10.3390/medicina59061058.
DAT, V.Q.; et al. Effectiveness of Continuous Endotracheal Cuff Pressure Control for the Prevention of Ventilator-Associated Respiratory Infections: An Open-Label Randomized, Controlled Trial. Clin Infect Dis, v. 74(10), p. 1795-1803, 2022. DOI: 10.1093/cid/ciab724.
FROST, S.A.; et al. Evidence for the effectiveness of chlorhexidine bathing and health care-associated infections among adult intensive care patients: a trial sequential meta-analysis. BMC Infect Dis, v. 18(1), 2018. DOI: 10.1186/s12879-018-3521-y.
HAMMOND, N.E.; et al. Association Between Selective Decontamination of the Digestive Tract and In-Hospital Mortality in Intensive Care Unit Patients Receiving Mechanical Ventilation: A Systematic Review and Meta-analysis. JAMA, v. 328(19), p. 1922-1934, 2022. DOI: 10.1001/jama.2022.19709.
HUANG, W.M.; et al. Tapered Cuff versus Conventional Cuff for Ventilator-Associated Pneumonia in Ventilated Patients: A Meta-Analysis of Randomized Controlled Trials. Can Respir J, v. 2019 7876417, 2019. DOI: 10.1155/2019/7876417.
HURLEY, J.C. Length of intensive care unit stay and the apparent efficacy of antimicrobial-based versus non-antimicrobial-based ventilator pneumonia prevention interventions within the Cochrane review database. J Hosp Infect, v. 140, p. 46-53, 2023. DOI: 10.1016/j.jhin.2023.07.018.
JAHANSHIR, M.; et al. Effect of clove mouthwash on the incidence of ventilator-associated pneumonia in intensive care unit patients: a comparative randomized triple-blind clinical trial. Clin Oral Invest, v. 27(7), p. 2589-3600, 2023. DOI: 10.1007/s00784-023-04972-w.
JAMESON, J.L.; et al. Medicina Interna de Harrison. 20 ed. Porto Alegre : AMGH, 2020.
JOHNSTONE, J.; et al. Effect of Probiotics on Incident Ventilator-Associated Pneumonia in Critically Ill Patients: A Randomized Clinical Trial. JAMA, v. 326(11), p. 1024-1033, 2021. DOI: 10.1001/jama.2021.13355.
KALIL, A.C.; et al. Executive Summary: Management of Adults with Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis, v. 63(5), p. 575-582, 2016. DOI: 10.1093/cid/ciw504.
KAO, C.C.; et al. National bundle care program implementation to reduce ventilator-associated pneumonia in intensive care units in Taiwan. J Microbiol Immunol Infect, v. 52(4), p. 592-597. DOI: 10.1016/j.jmii.2017.11.001.
KHAREL, S.; et al. Ventilator-associated pneumonia among ICU patients in WHO Southeast Asian region: A systematic review. PLoS One, v. 16(3), 2021. DOI: 10.1371/journal.pone.0247832.
LA COMBE, B.; et al. Oropharyngeal Bacterial Colonization after Chlorhexidine Mouthwash in Mechanically Ventilated Critically Ill Patients. Anesthesiology, v. 129(6), p. 1140-1148, 2018. DOI: 10.1097/ALN.0000000000002451.
LEE, H.H.; et al. Application of an Automatic Medical Information System to Implement Bundle Care for the Prevention of Ventilator-Associated Pneumonia. Int Environ Res Public Health, v. 18(21), 2021. DOI: 10.3390/ijerph182111128.
LI, D.; et al. Prevention of neonatal ventilator-associated pneumonia through oral care with the combined use of colostrum and sodium bicarbonate. Eur Rev Med Pharmacol Sci, v. 25(5), p. 2361-2366, 2021. DOI: 10.26355/eurrev_202103_25275.
LIU, W.; et al. Evaluation of the effects of applying the ventricular care bundle (VCB) method for reducing ventilator-associated pneumonia (VAP) in the intensive care unit of a general Chinese tertiary hospital. Ann Palliat Med, v. 9(5), p. 2853-2861, 2020. DOI: 10.21037/apm-20-289.
LORD, A.S.; et al. Infection Prevention in the Neurointensive Care Unit: A Systematic Review. Neurocrit Care, v. 31(1), p. 196-210, 2019. DOI: 10.1007/s12028-018-0568-y.
MODI, A.R.; KOVACS, C.S. Hospital-acquired and ventilator-associated pneumonia: Diagnosis, management, and prevention. Cleve Clin J Med, v. 87(10), p. 633-639, 2020. DOI: 10.3949/ccjm.87a.19117.
MOGYORODI, B.; et al. Effect of an educational intervention on compliance with care bundle items to prevent ventilator-associated pneumonia. Intensive Crit Care Nurs, v. 75, 2023. DOI: 10.1016/j.iccn.2022.103342.
OLIVEIRA, A.R.; et al. Manual da Residência de Medicina Intensiva. 6 ed. Barueri [SP] : Manole, 2020.
PALLOTTO, C.; et al. Daily bathing with 4% chlorhexidine gluconate in intensive care settings: a randomized controlled trial. Clin Microbiol Infect, v. 25(6), p. 705-710, 2019. DOI: 10.1016/j.cmi.2018.09.012.
PAPAZIAN, L.; KLOMPAS, M.; LUYT, C.E. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med, vol. 46(5) : 888-906, 2020. DOI:10.1007/s00134-020-05980-0.
PINTO, A.C.S.; et al. Efficiency of different protocols for oral hygiene combined with the use of chlorhexidine in the prevention of ventilator-associated pneumonia. J Bras Pneumol, v. 47(1), 2021. DOI: 10.36416/1806-3756/e20190286.
REIS, M.A.O.; et al. Chlorhexidine gluconate bathing of adult patients in intensive care units in São Paulo, Brazil: Impact on the incidence of healthcare-associated infection. Braz J Infect Dis, v. 26(1), 2022. DOI: 10.1016/j.bjid.2021.101666.
SAFAVI, A.; et al. The effect of an infection control guideline on the incidence of ventilator-associated pneumonia in patients admitted to the intensive care units. BMC Infect Dis, v. 23(1), 2023. DOI: 10.1186/s12879-023-08151-w.
SAFDAR, N.; CRNICH, C.J.; MAKI, D.G. The pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention. Respiratory care, vol. 50(6): 725-39; 739-41, 2005.
SOUZA, M.T.; SILVA, M.D.; CARVALHO, R. Revisão integrativa: o que é e como fazer. Einstein (São Paulo), v. 8, p. 102-106, 2010.
STAFYLAKI, D.; et al. Impact of Molecular Syndromic Diagnosis of Severe Pneumonia in the Management of Critically Ill Patients. Microbiol Spectr, v. 10(5), 2022. DOI: 10.1128/spectrum.01616-22.
TINCU, R.C.; et al. Efficacy of Noble Metal–alloy Endotracheal Tubes in Ventilator-associated Pneumonia Prevention: a Randomized Clinical Trial. Balkan Med J, v. 39(3), p. 167-171, 2022. DOI: 10.4274/balkanmedj.galenos.2021.2021-7-86.
WANG, B.; et al. A meta-analysis of the effects of probiotics on various parameters in critically ill ventilated individuals. Adv Clin Exp Med, v. 32(6), p. 633-642, 2023. DOI: 10.17219/acem/157407.
WANG, B.; et al. Ecological effects of selective oral decontamination on multidrug-resistance bacteria acquired in the intensive care unit: a case-control study over 5 years. Intensive Care Med, v. 48(9), p. 1165-1175, 2022. DOI: 10.1007/s00134-022-06826-7.
YI, X.; et al. Efficacy of comprehensive unit-based safety program to prevent ventilator associated-pneumonia for mechanically ventilated patients in China: A propensity-matched analysis. Front Public Health, v.10, 2022. DOI: 10.3389/fpubh.2022.1029260.