A predictive risk index for nosocomial pneumonia in the intensive care unit

Joshi, Nirmal; Localio, A. Russell; Hamory, Bruce H.

doi:10.1016/0002-9343(92)90042-a

Cited by 152 publications

(56 citation statements)

References 9 publications

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“…3 Tracheobronchial aspiration of oropharyngeal secretions and gastric contents has been cited as a cause of VAP. 4,5 Additionally, lower head-of-bed (HOB) elevations have been associated with higher rates of aspiration. [6][7][8][9][10][11] Despite the evidence that HOB elevation (30º-45º) helps prevent aspiration in patients receiving mechanical ventilation, the intervention is underused.…”

Section: Study Design and Settingmentioning

confidence: 99%

A Nursing Clinical Decision Support System and Potential Predictors of Head-of-Bed Position for Patients Receiving Mechanical Ventilation

Lyerla

LeRouge

Cooke

et al. 2010

American Journal of Critical Care

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Background Patients receiving mechanical ventilation are at high risk for pneumonia due to aspiration. Published guidelines recommend elevating the head of the bed 30º to 45º, if not contraindicated, to reduce risk, but this intervention is underused. Objectives To facilitate incorporating evidence-based practice by improving positioning of patients receiving mechanical ventilation and to identify patient and nurse characteristics that predict use of the guideline. Methods A modified interrupted time-series design was used. Data were collected on 43 patients and 33 nurses 3 separate times in a 12-bed intensive care unit at a medium-sized hospital. A total of 105 observations were recorded for analysis each time. Results Mean elevations of the head of the bed increased significantly from phase 1 (27.7º) to phase 2 (31.7º) and from phase 1 to phase 3 (31.1º). Elevations were higher for tube-fed patients than for patients not given enteral tube feedings. Elevations were higher for patients with a pulmonary-related diagnosis and lower for patients with a gastrointestinal diagnosis than for patients with other diagnoses. Elevations were lower for patients with a body mass index between 25.0 and 29.9 (overweight) than for patients with other body mass index values. Nurse characteristics were not significant predictors of elevation. Conclusion A nursing clinical decision support system integrated into a patient's electronic flow sheet can increase nurses' adherence to guidelines. Pulmonary and gastrointestinal diagnoses, body mass index, and tube feeding are predictors of elevation of the head of the bed.

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Section: Study Design and Settingmentioning

confidence: 99%

A Nursing Clinical Decision Support System and Potential Predictors of Head-of-Bed Position for Patients Receiving Mechanical Ventilation

Lyerla

LeRouge

Cooke

et al. 2010

American Journal of Critical Care

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“…Se ha establecido que el género, grupos de edad extrema, disminución de nivel de conciencia, hospitalización mayor de 14 días, intubación endotraqueal, sonda naso-gástrica, ventilación mecánica (VM) prolongada, uso previo de antibióticos, enfermedad cardiorrespiratoria, enfermedad coexistente grave, infiltrados pulmonares bilaterales, signos de dificultad respiratoria, traqueotomía, terapia antibiótica inadecuada, rehospitalización, reintubación y la virulencia del microorganismo causal son factores de riesgo para neumonía nosocomial (1)(2)(3)(4)(5)(6)(7)(8).…”

Section: Introductionunclassified

Neumonia Nosocomial

Ostos

Cifuentes

Barbosa

et al. 2006

nova

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ResumenSe definen como infecciones nosocomiales las que ocurren después de 48 horas de hospitalización. Las Unidades de Cuidados Intensivos neonatales, pediátricas y de adultos son las áreas de mayor prevalencia debido al perfil del paciente, a las terapias y a los procedimientos invasivos a los que son sometidos quienes ingresan. De las infecciones intrahospitalarias, una de las más conocidas y caracterizadas es la neumonía, la cual representa la segunda causa de infección nosocomial, con un aumento en la morbi-mortalidad cuando se encuentra asociada a ventilación mecánica. Su epidemiología está muy bien documentada en adultos, pero existe poca información en niños y neonatos.Palabras claves: broncoscopia, infección nosocomial, neonato, neumonía, ventilación mecánica. AbstractNosocomial infections are those which occur 48 hours after being hospitalized. The newborn, paediatric, and adult ICU's are the most prevalent areas due to the patient profile, therapies and invasive procedures that inpatients have to undergo. Pneumonia is one of the most known and characterized hospital infections. It represents the second cause of nosocomial infection which augments morbid-mortality when it is associated to mechanical ventilation. Its epidemiology is very well documented in adults, but there is very little information on children and newborns.

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“…In the present study, both study groups were similar regarding characteristics that may have affected VAP frequency (age, diagnosis on admission, APACHE II score, history of transports out of the ICU, diagnosis of paranasal sinusitis and history of cardiovascular disease) [5,7]. A standard treatment protocol was used to ensure that no known confounding factors would influence the difference in frequency of VAP between the two study groups.…”

Section: Discussionmentioning

confidence: 96%

“…Presence of a nasogastric tube has been recognised as one of the risk factors for the development of VAP [7,8]. It is possible that use of an alternative method to provide enteral feedings could decrease the frequency of VAP.…”

Section: Discussionmentioning

confidence: 99%

“…In most patients receiving MV, a nasogastric tube is placed for evacuation of gastric secretions and for nutritional support. The presence of a nasogastric tube has been identified as an independent risk factor for VAP [7,8]. The potential advantage of performing an early gastrostomy over using a nasogastric tube is the possibility of avoiding dysfunction of the upper and lower oesophageal sphincters and development of maxillary sinusitis, both of which are associated with VAP [9,10].…”

mentioning

confidence: 99%

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Early gastrostomy reduces the rate of ventilator-associated pneumonia in stroke or head injury patients

Kostadima

Kaditis²,

Alexopoulos³

et al. 2005

Eur Respir J

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Presence of a nasogastric tube is a risk factor for the development of ventilatorassociated pneumonia (VAP). Alternatively, gastrostomy can be used for administration of enteral feedings.To determine whether early performance of gastrostomy affects frequency of VAP, a randomised, controlled study was carried out in patients mechanically ventilated for stroke or head injury. In the gastrostomy group, patients underwent the procedure within 24 h of intubation. A nasogastric tube was inserted in controls. Individual subjects were studied for 3 weeks.In total, 20 subjects (mean age 48¡15.2 yrs) were allocated to the gastrostomy group, and 21 to the control group (46.6¡15.4 yrs). Of these groups, two (10%) and eight (38.1%) developed VAP, respectively. Four patients with gastrostomy and three controls did not complete the study (due to weaning from ventilatory support or death). After excluding these subjects, difference in VAP frequency persisted: two out of 16 subjects with gastrostomy had VAP (12.5%) versus eight out of 18 controls (44.4%). There were no differences in duration of hospitalisation or mortality between the two groups.In conclusion, in patients mechanically ventilated for stroke or head injury early gastrostomy is associated with a lower frequency of ventilator-associated pneumonia compared with a nasogastric tube.

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A predictive risk index for nosocomial pneumonia in the intensive care unit

Cited by 152 publications

References 9 publications

A Nursing Clinical Decision Support System and Potential Predictors of Head-of-Bed Position for Patients Receiving Mechanical Ventilation

A Nursing Clinical Decision Support System and Potential Predictors of Head-of-Bed Position for Patients Receiving Mechanical Ventilation

Neumonia Nosocomial

Early gastrostomy reduces the rate of ventilator-associated pneumonia in stroke or head injury patients

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