Chronic Obstructive Pulmonary Disease and Ventilator-Associated Pneumonia

The Clinical Nurse Leader (CNL) is a master's prepared nurse envisioned to provide clinical leadership at the microsystem level to ensure safe, high quality patient-centered care. The American Association of Colleges of Nurses defined ten 'fundamental aspects' of CNL practice, but as the certified CNL population grows, data suggest they are filling a variety of positions besides formally designated CNL roles. This article reports the results of a systematic review of CNL literature to better understand what roles and activities certified CNLs are enacting when not hired into formally designated CNL roles. Sixty-nine articles met inclusion criteria. Roles identified include: faculty, 62%; clinical management/executive, 12%; specialty clinician, 11%; and staff nurse, 9%. In these roles, certified CNLs are reviewing literature, conducting research, and/or writing commentaries on CNL education and practice and other health foci such as alarm fatigue, insulin practices, and physical exercise for cancer-related fatigue. Results indicate that despite a lack of formal tracking of certified CNLs over time, the available information identifies a variety of roles and job titles used by this group of professional nurses. The study findings add to the body of knowledge informing overall understanding of the CNL initiative.

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Roles enacted by Clinical Nurse Leaders across the healthcare spectrum: A systematic literature review

Clavo-Hall

Bender

Harvath

2018

Journal of Professional Nursing

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Assessing the Impact of Gender and COPD on the Incidence and Mortality of Hospital-Acquired Pneumonia. A Retrospective Cohort Study Using the Spanish National Discharge Database (2016–2019)

de-Miguel-Díez

Jiménez‐García

Hernández‐Barrera

et al. 2021

JCM

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Background: We aim to analyze incidence and outcomes of patients hospitalized with hospital-acquired pneumonia (HAP) according to chronic obstructive pulmonary disease (COPD) status and sex in Spain (2016–2019). Methods: We conducted a retrospective cohort study using national hospital discharge data of patients ≥40 years with a primary diagnosis of HAP, using the specific diagnostics of non-ventilator (NV)-HAP and ventilator-associated pneumonia (VAP). Results: We identified 37,029 patients with HAP ((NV)-HAP 87.28%, VAP 12.72%), 13.40% with COPD. HAP incidence increased over time, but only in subjects without COPD (p < 0.001). In women, incidence of HAP and (NV)-HAP was similar regardless of COPD status, but VAP incidence was lower in COPD women (p = 0.007). In men, the incidence of (NV)-HAP was significantly higher in those with COPD, while VAP incidence was lower in COPD men (p < 0.001). The in-hospital mortality (IHM) was similar in men and women with and without COPD. The risk of dying in hospital increased with age, congestive heart failure, cancer, and dialysis among men and women with COPD. Men that underwent surgery had a lower risk of IHM. VAP increased 2.58-times the probability of dying in men and women. Finally, sex was not associated with IHM among COPD patients. Conclusions: Incidence of HAP was significantly higher in COPD patients than in those without COPD, at the expense of (NV)-HAP but not of VAP. When stratifying by sex, we found that the difference was caused by men. IHM was similar in COPD and non-COPD patients, with no significant change overtime. In addition, sex was not associated with IHM.

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Continuous Versus Intermittent Subglottic Secretion Drainage to Prevent Ventilator-Associated Pneumonia: A Systematic Review

Wen¹,

Zhang²,

Ding³

et al. 2017

Crit Care Nurse

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Background Ventilator-associated pneumonia is associated with high morbidity and mortality in patients receiving mechanical ventilation. Subglottic secretion drainage, which may be performed continuously or intermittently, is believed to be an effective strategy for coping with ventilator-assisted pneumonia. Whether continuous or intermittent subglottic secretion drainage is superior for preventing ventilatorassisted pneumonia remains unknown. Methods This study is a comprehensive, systematic meta-analysis of randomized trials comparing continuous and intermittent subglottic secretion drainage in patients receiving mechanical ventilation. Studies in English and Chinese published from January 1970 through November 2015 were identified by searching multiple databases. Summary risk ratios or weighted mean differences with 95% CIs were used to calculate each outcome by means of fixed-or random-effects models. Results Eight studies enrolling a total of 1071 patients met the inclusion criteria. The summary risk ratio between continuous and intermittent subglottic secretion drainage for incidence of ventilator-assisted pneumonia was 0.83 (95% CI, 0.61-1.13); for time to ventilator-assisted pneumonia occurrence, 2.73 (95% CI, -0.39 to 5.85); for occult blood, 2.34 (95% CI, 0.25-21.88); for duration of mechanical ventilation, -0.89 (95% CI, -2.72 to 0.94); for length of intensive care unit stay, 3.98 (95% CI, -4.44 to 12.41); and for mortality, 0.80 (95% CI, 0.48-1.31). Conclusions The results indicate no apparent differences between continuous and intermittent subglottic secretion drainage for the treatment outcomes included in the analysis. Rigorously designed, large-scale randomized controlled trials are warranted to identify the roles of continuous and intermittent subglottic secretion drainage. (Critical Care Nurse. 2017;37[5]:e10-e17)

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Chronic Obstructive Pulmonary Disease and Ventilator-Associated Pneumonia

Cited by 4 publications

References 30 publications

Roles enacted by Clinical Nurse Leaders across the healthcare spectrum: A systematic literature review

Roles enacted by Clinical Nurse Leaders across the healthcare spectrum: A systematic literature review

Assessing the Impact of Gender and COPD on the Incidence and Mortality of Hospital-Acquired Pneumonia. A Retrospective Cohort Study Using the Spanish National Discharge Database (2016–2019)

Continuous Versus Intermittent Subglottic Secretion Drainage to Prevent Ventilator-Associated Pneumonia: A Systematic Review

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