The Intensive Care Society recommended bundle of interventions for the prevention of ventilator-associated pneumonia

Hellyer, Thomas P; Ewan, Victoria; Wilson, Peter; Simpson, A. John

doi:10.1177/1751143716644461

Cited by 115 publications

(116 citation statements)

References 47 publications

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“…Pulse pressure variation, cardiac index and MAP‐based cardiac output monitoring are all essentially targeting the same area. Contrast this with elements used in bundles for ventilator‐acquired pneumonia , enhanced recovery programmes or emergency laparotomy care . However, there remains the issue of teasing out the effective versus the ineffective element of the bundle.…”

Section: It Does Work But… Only As Part Of a Bundle Of Carementioning

confidence: 99%

What should we do when traditional research fails?

Murray

2017

Anaesthesia

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Section: It Does Work But… Only As Part Of a Bundle Of Carementioning

confidence: 99%

What should we do when traditional research fails?

Murray

2017

Anaesthesia

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“…Moreover, there is an association of VAP with an increased length of hospitalisation and with higher hospital costs (Cooper & Haut, ). The factors that predispose to acquiring VAP include intubation and prolonged mechanical ventilation, severe underlying illness, inadequate mouth care, and an extensive use of invasive devices and procedures (Grohskopf, Sinkowitz‐Cochran, Garrett, Sohn, & Levine, ; Hellyer, Ewan, Wilson, & Simpson, ).…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, there is an association of VAP with an increased length of hospitalisation and with higher hospital costs (Cooper & Haut, 2013). The factors that predispose to acquiring VAP include intubation and prolonged mechanical ventilation, severe underlying illness, inadequate mouth care, and an extensive use of invasive devices and procedures (Grohskopf, Sinkowitz-Cochran, Garrett, Sohn, & Levine, 2002;Hellyer, Ewan, Wilson, & Simpson, 2016 Improvement, 2012). In addition, the care bundle approach to prevent VAP is considered an essential element of patient safety in the treatment and care of critically ill paediatric patients (Coffin et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

What are the effects of care bundles on the incidence of ventilator‐associated pneumonia in paediatric and neonatal intensive care units? A systematic review

Niedzwiecka

Patton

Walsh

et al. 2019

Specialist Pediatric Nursing

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Purpose The purpose of this review was to ascertain the impact of ventilator bundles on the incidence of ventilator‐associated pneumonia in mechanically ventilated neonates and children in intensive care units. Methods A systematic review was conducted. Key computerised databases (CINAHL, Medline, Embase and Cochrane) as well as additional sources, with no publication date limitations, were extensively searched in January 2018. Inclusion criteria focused on ventilator bundles used in mechanically ventilated neonates and children aged from 0 to 18 years. After identification and inclusion, all studies were critically appraised for quality. Data were analysed and narratively synthesised. Results Eight studies of observational and nonrandomised interventional methods design were included in the review. However, the validity of five of the eight studies which were reviewed was considered substandard. In addition, there were variations in the care bundles elements studied. Nevertheless, all these studies demonstrated that the incidences of VAP in mechanically ventilated neonates and children were found to be significantly reduced by the use of ventilator bundles. Practice Implications This systematic review determines that ventilator bundles impact positively on the incidence of VAP in critically ill neonates and children in the neonatal intensive care unit and paediatric intensive care unit. However, the variations in the bundle elements and insufficient valid evidence necessitates further research in the area to validate the findings and to ensure standardisation of clinical practice. Prevention of VAP is aimed at avoiding the risk of aspiration in the lungs, colonisation of respiratory tract with pathogenic microorganisms and contamination of respiratory equipment. Moreover, the implementation of evidence‐based interventions grouped together is fundamental to improve patient outcomes. It is recommended that a further bona fide research is required to standardise the components of paediatric ventilator bundles.

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“…In addition, systemic disease (e.g. ventilator‐associated pneumonia [VAP], sepsis) may result from translocation of oral bacteria to the lower airways (Hellyer, Ewan, Wilson, & Simpson, ). Oral health deterioration during intensive care unit (ICU) treatment contributes to the burden of critical illness with consequential impact on the duration of ICU stay and costs of treatment (Sands et al, ).…”

Section: Introductionmentioning

confidence: 99%

Exploration of difficulty accessing the mouths of intubated and mechanically ventilated adults for oral care: A video and photographic elicitation study

Dale

Angus

Sutherland

et al. 2019

Journal of Clinical Nursing

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Aim:To explore descriptors of difficulty accessing the mouths of intubated and mechanically ventilated adults for oral care, consequences, modifiable antecedents and recommendations for improving care delivery.Background: Nurses report oral access and care delivery difficulty in most mechanically ventilated patients. Design:A prospective qualitative descriptive design.Methods: Data were collected using video and photographic elicitation interviews focused on delivery of oral care. Directed content analysis was used to explore descriptive categories. Reporting used the SRQR guidelines. Setting and participants:A university-affiliated hospital in Toronto, Canada.Participants included clinicians experienced in accessing the oral space of adults representing nursing, medicine, dentistry and allied health professionals.Findings: We recruited 18 participants; 9 representing critical care and 9 other specialties frequently accessing the mouth, that is dentistry. Descriptors for observed difficulty accessing the oral cavity were "oral crowding with tubes" and "aversive patient responses", which were considered to result in insufficient oral care.Participants perceived aversive patient responses (e.g. biting, turning head side to side, gagging, coughing) as a consequence of forced introduction of instruments inside a crowded mouth. A key finding identified by participants was the observation of substantial procedural pain during oral care interventions. Potentially modifiable antecedents to difficult oral care delivery identified were procedural pain, oral health deterioration (e.g. xerostomia) and lack of interprofessional team problem-solving.Recommendations to address these antecedents included patient preparation for oral care through verbal and nonverbal cueing, pharmacological and nonpharmacological strategies, and ICU interprofessional education. Conclusions:Oral care in mechanically ventilated adults is complex and painful. Visual research methods offer important advantages for oral care exploration including its | 1921 DALE Et AL.

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The Intensive Care Society recommended bundle of interventions for the prevention of ventilator-associated pneumonia

Cited by 115 publications

References 47 publications

What should we do when traditional research fails?

What should we do when traditional research fails?

What are the effects of care bundles on the incidence of ventilator‐associated pneumonia in paediatric and neonatal intensive care units? A systematic review

Exploration of difficulty accessing the mouths of intubated and mechanically ventilated adults for oral care: A video and photographic elicitation study

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