Effectiveness of a Ventilator Care Bundle to Prevent Ventilator-Associated Pneumonia at the PICU: A Systematic Review and Meta-Analysis

Neef, Marjorie de; Bakker, Leo; Dijkstra, Sandra; Raymakers-Janssen, Paulien; Vileito, Alicija; Ista, Erwin

doi:10.1097/pcc.0000000000001862

Cited by 25 publications

(27 citation statements)

References 46 publications

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“…AEs, such as hospital‐acquired infections, have been shown to decrease when evidence‐based guidelines such as, ventilator‐associated pneumonia prevention guideline, are followed 29‐32 . In addition, the frequencies of infections were found to decrease substantially depending on the design of the ICU and by caring for intensive care patients in single‐patient rooms rather than multibed rooms 33,34 .…”

Section: Introductionmentioning

confidence: 99%

Associations between healthcare environment design and adverse events in intensive care unit

Sundberg

Fridh

Lindahl

et al. 2020

Nursing in Critical Care

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Background Healthcare environment can affect health. Adverse events (AEs) are common because rapid changes in the patients' status can suddenly arise, and have serious consequences, especially in intensive care. The relationship between the design of intensive care units (ICUs) and AEs has not been fully explored. Hence, an intensive care room was refurbished with cyclic lightning, sound absorbents and unique interior, and exterior design to promote health. Aims The aim of this study was to evaluate the differences between a regular and a refurbished intensive care room in risk for AEs among critically ill patients. Design This study retrospectively evaluated associations of AEs and compared the incidence of AEs in patients who were assigned to a multidisciplinary ICU in a refurbished two‐bed patient room with patients in the control rooms between 2011 and 2018. Methods There were 1938 patients included in this study (1382 in control rooms; 556 in the intervention room). Descriptive statistics were used to present the experienced AEs. Binary logistic regressions were conducted to estimate the relationship between the intervention/control rooms and variables concerning AEs. Statistical significance was set at P < 0.05. Results For the frequency of AEs, there were no significant differences between the intervention room and the control rooms (10.6% vs 11%, respectively, P < 0.805). No findings indicated the intervention room (the refurbished room) had a significant influence on decreasing the number of experienced AEs in critically ill patients. Conclusions The findings revealed a low incident of AEs in both the intervention room as well as in the control rooms, lower than previously described. However, our study did not find any decreases in the AEs due to the design of the rooms. Relevance to clinical practice Further research is needed to determine the relationship between the physical environment and AEs in critically ill patients.

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Section: Introductionmentioning

confidence: 99%

Associations between healthcare environment design and adverse events in intensive care unit

Sundberg

Fridh

Lindahl

et al. 2020

Nursing in Critical Care

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“…At present, the clinical diagnosis of VAP is mainly based on clinical symptoms and signs, lung imaging, and sputum bacteriological test, which, however, have low specificity and cannot accurately determine bacterial, fungal, and viral infections. Moreover, the bacteriological test lasts for a long time, delaying the treatment (9). It was found in previous clinical practice that PCT can be used to diagnose early potential infection in patients with VAP more accurately (10).…”

Section: Discussionmentioning

confidence: 99%

Values of PCT and STREM-1 combined with clinical pulmonary infection score for the prognostic evaluation of elderly patients with ventilator-associated pneumonia

Wang¹,

Zhu²,

Wang³

et al. 2022

Revista Romana De Medicina De Laborator

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Objective: To explore the values of PCT and STREM-1 combined with clinical pulmonary infection score (CPIS) for evaluating ventilator-associated pneumonia (VAP) in elderly patients. Methods: A total of 120 eligible patients were selected as VAP group, and 60 other patients without VAP were selected as control group. According to APACHE II scores, VAP group was divided into low-, medium-, and high-risk groups. The correlations of PCT, STREM-1, and CPIS with APACHE II score were analyzed. The values of PCT and STREM-1 combined with CPIS for evaluating prognosis were analyzed using ROC curves. Results: In the VAP group, serum PCT and STREM-1 levels and CPIS after mechanical ventilation significantly exceeded those of the control group and before mechanical ventilation (P<0.05). These values were higher in the high-risk group than in medium- and low-risk groups (P<0.05). They were positively correlated with APACHE II score (P<0.001). These values of the death group were significantly higher than those of the survival group 1, 3, 5, and 7 d after treatment (P<0.05). AUC of PCT and STREM-1 combined with CPIS for assessing prognosis was 0.892 (P<0.001). Conclusions: Serum PCT and STREM-1 levels and CPIS significantly increase in elderly patients with VAP, which rise with aggravation. Their combination has higher values for prognostic evaluation.

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“…This is also confirmed to a certain extent by the findings of Matics et al and Lalitha et al found that when pSOFA score was more than 8 on both days 1 and 3, the relative risk of prolonged duration of mechanical ventilation was increased ( 21 ). When the initial pSOFA score at the beginning of ventilator use is ≥8, the risk of mechanical ventilation duration ≥96 h is higher, so taking effective preventive measures in nursing and treatment can improve patient outcomes ( 22 ). For children with a score >8, chest radiographs should be performed 72 h after mechanical ventilation, so that VAP can be detected and treated early.…”

Section: Discussionmentioning

confidence: 99%

The Correlation Between Mechanical Ventilation Duration, Pediatric Sequential Organ Failure Assessment Score, and Blood Lactate Level in Children in Pediatric Intensive Care

Hua

2022

Front. Pediatr.

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ObjectiveThis study aimed to investigate whether the ventilation duration for children undergoing invasive mechanical ventilation (IMV) in pediatric intensive care unit (PICU) is correlated with pediatric sequential organ failure (pSOFA) score, white blood cell (WBC) count, blood lactate level, and duration of fever.MethodsRetrospectively reviewed that the medical records of patients who received IMV in the PICU of Jingzhou Central Hospital between January 2018 and December 2020. According to the duration of IMV in diagnosis-related groups, these patients were divided into two groups: group A, ventilation duration <96 h, and group B, ventilation duration ≥96 h. Each group's pSOFA scores, WBC counts, blood lactate levels, and durations of fever were compared. Logistic regression analysis was used to analyze the clinical risk factors of ventilation duration ≥96 h, and the receiver operator characteristic (ROC) curve was drawn.ResultsA total of 42 patients were included, including 23 in group A and 19 in group B. The difference in pSOFA score between group A and group B was statistically significant (P < 0.05), while the differences in blood lactate level, duration of fever, and WBC count between the two groups were not statistically significant (P > 0.05). Logistic regression analysis was conducted to analyze the influencing factors of mechanical ventilation duration ≥96 h. An ROC curve was drawn with pSOFA score as a test variable and duration of mechanical ventilation ≥96 h as a state variable, revealing that the area under the curve was 0.76 (SE = 0.075, 95% CI: 0.614–0.906, P = 0.005). The sensitivity and specificity were 68.4 and 73.9%, respectively, and the corresponding pSOFA score was 7.5.ConclusionWhen the pSOFA score ≥8, the risk of mechanical ventilation duration ≥96 h increases.

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Effectiveness of a Ventilator Care Bundle to Prevent Ventilator-Associated Pneumonia at the PICU: A Systematic Review and Meta-Analysis

Abstract: Objectives: Ventilator-associated pneumonia is one of the most frequent hospital-acquired infections in mechanically ventilated children. We reviewed the literature on the effectiveness of ventilator care bundles in critically ill children.

Cited by 25 publications

References 46 publications

Associations between healthcare environment design and adverse events in intensive care unit

Associations between healthcare environment design and adverse events in intensive care unit

Values of PCT and STREM-1 combined with clinical pulmonary infection score for the prognostic evaluation of elderly patients with ventilator-associated pneumonia

The Correlation Between Mechanical Ventilation Duration, Pediatric Sequential Organ Failure Assessment Score, and Blood Lactate Level in Children in Pediatric Intensive Care

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