Impact of nosocomial pneumonia on the outcome of mechanically-ventilated patients

Violan, J. Sole; Sánchez-Ramírez, Carlos Jerjes; Mujica, A. Padron; Cendrero, JA Cardeñosa; Fernandez, J.; Castro, Felipè Rodríguez de

doi:10.1186/cc119

Cited by 19 publications

(2 citation statements)

References 24 publications

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“…It is also the most serious complication of MV, as it contributes to an increase in patient mortality, morbidity, length of hospital stays, and financial cost. 8 , 9 , 10 Since VAP occurs in critically ill patients, it is difficult to determine the exact mortality of VAP. However, Melson et al 11 have reported that VAP has an estimated attributable mortality rate of 13%.…”

Section: Introductionmentioning

confidence: 99%

Impact of staffing levels and resources of intensive care units on compliance to standard mechanical ventilator guidelines: A city‐wide study in times of COVID‐19 pandemic

Rashid

Ansar

Khan³

et al. 2022

Nursing in Critical Care

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Introduction The COVID‐19 pandemic has affected millions and resulted in a considerable strain on healthcare systems around the world. Intensive care units (ICUs) are reported to be affected the most because significant percentage of ICU patients requires respiratory support through mechanical ventilation (MV). This study examines the staffing levels and compliance with a ventilator care bundle in a single city in Pakistan. Methods A cross‐sectional survey of 14 ICUs including medical and surgical ICUs was conducted through a self‐structured questionnaire including a standardized ventilator care bundle. We assessed the compliance of ICU staff to ventilator care bundle and calculated the correlation between staffing patterns with compliance to this bundle. Results The unit response rate was 64% (7/11 hospitals). Across these seven hospitals, there were 14 functional ICUs (7 surgical and 7 medical). The Mean (SD) numbers of beds and ventilators were 8.14 (3.39) and 5.78 (3.68) while the average patient‐to‐nurse and patient‐to‐doctor ratio was 3: 1 and 5:1 respectively. The median ventilator care bundle compliance score was 26 (IQR = 21–28) out of 30, while in medical and surgical ICUs, median scores were 24 (IQR = 19–26) and 28 (IQR = 23–30) respectively. The perceived least compliant component was head elevation in ventilated patients. Correlation analysis revealed that 24 h a day, 7 days a week onsite cover of Advanced Cardiovascular Life Support certified staff was positively correlated with the ventilator care bundle score ( r s = 0.654, p value = .011). Similarly, 24‐h cover of senior ICU nurses was significantly correlated with the application of chlorhexidine oral care ( r s = 0.676, p value = .008) while routine subglottic aspiration was correlated with the number of doctors ( r s = 0.636, p value = .014). Conclusion Our study suggests that ICUs in Peshawar are not well staffed in comparison with international standards and the compliance of ICUs with the ventilator care bundle is suboptimal. We found only a few aspects of ventilator care bundle compliance were related to nursing and medical staffing levels. Relevance to clinical practice Critical care staffs at most of the medical ICUs in Peshawar are not compliant with the standard guidelines for patients on mechanical ventilation. Moreover, the staffing levels at these ICUs are not in accordance with international standards. However, this study suggests that staffing levels may not be the only cause of non‐compliance with standard mechanical ventilator guidelines. There is an urgent need to design and implement a program that can enhance and monitor the quality of nursing care provided to mechanically...

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Section: Introductionmentioning

confidence: 99%

Impact of staffing levels and resources of intensive care units on compliance to standard mechanical ventilator guidelines: A city‐wide study in times of COVID‐19 pandemic

Rashid

Ansar

Khan³

et al. 2022

Nursing in Critical Care

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“…Currently, established empiric antibiotic strategies for patients with sepsis due to postoperative abdominal infections include single- and multiple-agent regimens [21,34,35,36]. Recommended regimens for therapy of nosocominal sepsis without knowledge of the presumable pathogen are carbapenems (imipenem/cilastatin or meropenem) and piperacillin plus tazobactam.…”

Section: Therapy Of Postoperative Bacterial/fungal Infectionsmentioning

confidence: 99%

Postoperative Bacterial/Fungal Infections: A Challenging Problem in Critically Ill Patients after Abdominal Surgery

Lichtenstern

Schmidt²,

Knaebel³

et al. 2007

Dig Surg

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Critically ill patients after extended surgical procedures are at high risk for postoperative infections. The overall incidence of sepsis increased constantly over the last decade, whereas sepsis-related mortality decreased, due to new intensive care options. After extended intra-abdominal surgery the abdomen is the predominant focus of sepsis, followed by respiratory tract infections. Unspecific clinical signs lead to the diagnosis of postoperative sepsis. Early focus identification by clinical, laboratory and radiologic examination is of major importance for a promising therapy, followed by immediately initiated procedures for source control and an adequate anti-infective drug therapy. For nosocomial sepsis, the use of antimicrobial regimens with extended spectra and potent activity against both Gram-negative and Gram-positive bacterial pathogens are warranted. Fungal infections play a great role for immunocompromized patients, e.g. after solid organ transplantation or under chronic corticoid therapy. An increasing incidence of multi-drug resistance in bacterial and fungal isolates has been observed in the last years. This is becoming a growing problem also for critically ill patients after abdominal surgery. Standardized treatment protocols including supportive and adjunctive therapy and the use of modern anti-infective agents may lead to a decrease in postoperative mortality due to sepsis.

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Minimal Surgical Procedures to Decrease the Stress Response and New Potential Therapeutic Agents

Baue¹

2000

Multiple Organ Failure

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Impact of nosocomial pneumonia on the outcome of mechanically-ventilated patients

Cited by 19 publications

References 24 publications

Impact of staffing levels and resources of intensive care units on compliance to standard mechanical ventilator guidelines: A city‐wide study in times of COVID‐19 pandemic

Impact of staffing levels and resources of intensive care units on compliance to standard mechanical ventilator guidelines: A city‐wide study in times of COVID‐19 pandemic

Postoperative Bacterial/Fungal Infections: A Challenging Problem in Critically Ill Patients after Abdominal Surgery

Minimal Surgical Procedures to Decrease the Stress Response and New Potential Therapeutic Agents

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