Effect of modified care bundle for prevention of ventilator-associated pneumonia in critically-ill neurosurgical patients

Triamvisit Suphannee; Wongprasert Wassana; Puttima Chalermwoot; Chiangmai Matchima Na; Thienjindakul Nawaphan; Rodkul Laksika; Jetjumnong Chumpon

doi:10.4266/acc.2021.00983

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자료유형: 학술저널

저자정보: Triamvisit Suphannee (Division of Nursing Chiang Mai University Hospital Chiang Mai) Wongprasert Wassana (Division of Nursing Chiang Mai University Hospital Chiang Mai) Puttima Chalermwoot (Division of Nursing Chiang Mai University Hospital Chiang Mai) Chiangmai Matchima Na (Division of Nursing Chiang Mai University Hospital Chiang Mai) Thienjindakul Nawaphan (Division of Nursing Chiang Mai University Hospital Chiang Mai) Rodkul Laksika (Division of Nursing Chiang Mai University Hospital Chiang Mai) Jetjumnong Chumpon (Chiang Mai University)

저널정보: 대한중환자의학회 Acute and Critical Care Acute and Critical Care 제36권 제4호

발행연도: 2021.11

수록면: 294 - 299 (6page)

DOI: 10.4266/acc.2021.00983

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Background: Care bundles for ventilator-associated pneumonia (VAP) have been shown to mini- mize the rate of VAP in critically ill patients. Standard care bundles may need to be modified in resource-constrained situations. The goal of this study was to see if our modified VAP-care bun- dles lowered the risk of VAP in neurosurgical patients. Methods: A prospective cohort study was conducted in mechanically ventilated neurosurgical patients. The VAP bundle was adjusted in the cohort group by increasing the frequency of inter- mittent endotracheal tube cuff pressure monitoring to six times a day while reducing oral care with 0.12% chlorhexidine to three times a day. The rate of VAP was compared to the historical control group. Results: A total of 146 and 145 patients were enrolled in control and cohort groups, respectively. The mean age of patients was 52±16 years in both groups (P=0.803). The admission Glasgow coma scores were 7.79±2.67 and 7.80±2.77 in control and cohort group, respectively (P=0.969). VAP was found in nine patients in control group but only one patient in cohort group. The occur- rence rate of VAP was significantly reduced in cohort group compared to control group (0.88/1,000 vs. 6.84/1,000 ventilator days, P=0.036). Conclusions: The modified VAP bundle is effective in lowering the VAP rate in critically ill neuro- surgical patients. It requires low budget and manpower and can be employed in resource-con- strained settings.

#chlorhexidine #critical care #intubation #neurosurgery #oral hygiene #ventilator-asso- ciated pneumonia

참고문헌 (31)

참고문헌 신청

Rello J / 2002 / Epidemiology and outcomes of ventilator-associated pneumonia in a large US database / Chest 122:2115~2121

Craven DE / 2000 / Epidemiology of ventilator-associated pneumonia / Chest 117(4 Suppl 2):186S~187S

Martin-Loeches I / 2018 / New guidelines for hospital-acquired pneumonia/ventilator-associated pneumonia: USA vs. Europe / Curr Opin Crit Care 24:347~352

Triamvisit S / 2016 / Results of an evidence-based care bundle for reducing ventilator-associated pneumonia(VAP)in neurosurgical patients / J Med Assoc Thai 99:1014~1019

Lorente L / 2014 / Continuous endotracheal tube cuff pressure control system protects against ventilator-associated pneumonia / Crit Care 18:R77

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