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Impact of four sequential measures on the prevention of ventilator-associated pneumonia in cardiac surgery patients.

ABSTRACT: Ventilator-associated pneumonia (VAP) is the most frequent infection in patients admitted to intensive care units.We compared rates of VAP, days on mechanical ventilation (MV), and cost of antimicrobial agents before and during implementation.We collected data from 401 patients before the intervention and from 1,534 patients during the intervention. Both groups were comparable. No significant differences in EuroSCORE were observed between the patients of both periods (6.4 versus 6.3; P?=?0.7). The rates of VAP (episodes/1,000 days of ventilation) were, respectively, 23.9 versus 13.5 (P?=?0.005). Mean number of days of MV/1,000 days of stay was 507 versus 375 (P?=?0.001), and the cost of antimicrobial therapy (Euros/1,000 days of stay) was €70,612 versus €52,775 (P?=?0.10). The main effect of sequential application of preventive measures in time achieved a relative-rate reduction of VAP of 41% (IRR, 0.41; 95% CI, 0.28 to 0.62). The mortality rate before and during the intervention was 13.0% and 10.2%, respectively.A sequentially applied bundle of four preventive measures reduces VAP rates, days of MV, and the cost of antimicrobial therapy in patients admitted to the major heart surgery ICU.Clinical Trials.gov: NCT02060045. Registered 4 February 2014.

SUBMITTER: Perez-Granda MJ

PROVIDER: S-EPMC4056787 | biostudies-literature | 2014 Mar

REPOSITORIES: biostudies-literature

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Impact of four sequential measures on the prevention of ventilator-associated pneumonia in cardiac surgery patients.

Pérez-Granda María Jesús MJ Barrio José María JM Muñoz Patricia P Hortal Javier J Rincón Cristina C Bouza Emilio E

Critical care (London, England) 20140326 2

<h4>Introduction</h4>Ventilator-associated pneumonia (VAP) is the most frequent infection in patients admitted to intensive care units.<h4>Methods</h4>We compared rates of VAP, days on mechanical ventilation (MV), and cost of antimicrobial agents before and during implementation.<h4>Results</h4>We collected data from 401 patients before the intervention and from 1,534 patients during the intervention. Both groups were comparable. No significant differences in EuroSCORE were observed between the ...[more]

PMID: 24667011

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Project description:Background and Objectives: Ventilator-associated pneumonia (VAP) poses a significant threat to the clinical outcomes and hospital stays of mechanically ventilated patients, particularly those recovering from cardiac arrest. Given the already elevated mortality rates in cardiac arrest cases, the addition of VAP further diminishes the chances of survival. Consequently, a paramount focus on VAP prevention becomes imperative. This review endeavors to comprehensively delve into the nuances of VAP, specifically in patients requiring mechanical ventilation in post-cardiac arrest care. The overarching objectives encompass (I) exploring the etiology, risk factors, and pathophysiology of VAP, (II) delving into available diagnostic modalities, and (III) providing insights into the management options and recent treatment guidelines. Methods: A literature search was conducted using PubMed, MEDLINE, and Google Scholar databases for articles about VAP and Cardiac arrest. We used the MeSH terms "VAP", "Cardiac arrest", "postcardiac arrest syndrome", and "postcardiac arrest syndrome". The clinical presentation, diagnostic, and management strategies of VAP were summarized, and all authors reviewed the selection and decided which studies to include. Key Content and Findings: The incidence and mortality rates of VAP exhibit significant variability, yet a recurring pattern emerges, marked by prolonged hospitalization and exacerbated clinical outcomes. This pattern is attributed to the elevated incidence of drug-resistant infections and the delayed initiation of antimicrobial treatment. This review focuses on VAP, aiming to offer valuable insights into the efficient identification and management of this fatal complication in post-cardiac arrest patients. Conclusion: The prognosis for survival after cardiac arrest is already challenging, and the outlook becomes even more daunting when complicated by VAP. The timely diagnosis of VAP and initiation of antibiotics pose considerable challenges, primarily due to the invasive nature of obtaining high-quality samples and the time required for speciation and identification of antimicrobial sensitivity. The controversy surrounding prophylactic antibiotics persists, but promising new strategies have been proposed; however, they are still awaiting well-designed clinical trials.

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Impact of four sequential measures on the prevention of ventilator-associated pneumonia in cardiac surgery patients.

Publications

Impact of four sequential measures on the prevention of ventilator-associated pneumonia in cardiac surgery patients.

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