International Journal of Advanced Culture Technology

The International Promotion Agency of Culture Technology (국제문화기술진흥원)
권호 표지
DOI QR코드

DOI QR Code

Secondary Analysis on Ventilator-Associated Pneumonia and Pressure Injury

  • Received : 2018.08.06
  • Accepted : 2018.08.30
  • Published : 2018.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Ventilator-associated pneumonia (VAP) is a lung infection that develops in patients receiving mechanical ventilation. VAP contributes to about 50% of hospital-acquired pneumonia in ICU settings. One of the recommendation of the Institute of for Healthcare Improvement ventilator bundle is HOB elevation. HOB elevation affects shearing forces and makes higher risk for pressure injury development. Pressure injury (PI) is localized damage to the skin over a bony prominence. PI prevention guidelines recommend that HOB positioning should be lower to reduce risk for PI development which contradicts VAP prevention guidelines for the HOB between 30 and 45 degrees for ICU patients. This presents a care dilemma and tension. The purpose of this study was to perform a secondary data analysis using cumulative electronic health record data in order to determine the association of HOB elevation with VAP and PI in ICU patients. A secondary data analysis was conducted to determine whether HOB elevation is associated with VAP and PI. HOB elevation was not likely to be associated with VAP prevention whereas it was likely to be related to PI development. This is somewhat contrary to popular data and publications. Prospective cohort study is desired to inform us in an evidence-based fashion what actually is optimal HOB elevation for ventilated patients in ICU settings.

Keywords

References

  1. Centers for Disease Control and Prevention. Ventilator-associated Pneumonia (VAP). May 17, 2012 [cited 2018 Aug 28]; Available from: https://www.cdc.gov/hai/vap/vap.html.
  2. Kalanuria AA, Ziai W, Mirski M. Ventilator-associated pneumonia in the ICU. Critical Care, 2014. 18: p. 208. 10.1186/cc13775
  3. Klompas M, et al. Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals: 2014 Update. Infection Control and Hospital Epidemiology, 2014. 35(8): p. 915-936. 10.1086/677144
  4. Skrupky L, et al. A comparison of ventilator-associated pneumonia rates as identified according to the National Healthcare Safety Network and American College of Chest Physicians criteria. Critical Care Medicine, 2012. 40(1): p. 281-4. 10.1097/CCM.0b013e31822d7913
  5. Rosenthal V, et al. International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module. Am J Infect Control, 2016. 44(12): p. 1495-1504. 10.1016/j.ajic.2016.08.007
  6. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med, 2002. 165(7): p. 867-903. 10.1164/ajrccm.165.7.2105078
  7. How-to Guide: Prevent Ventilator-Associated Pneumonia. 2012, Institute for Healthcare Improvement: Cambridge, MA.
  8. O'Grady N, Murray P, Ames N. Preventing ventilator-associated pneumonia: does the evidence support the practice? JAMA, 2012. 307(23): p. 2534-9. 10.1001/jama.2012.6445
  9. Wang L, et al. Semi-recumbent position versus supine position for the prevention of ventilator-associated pneumonia in adults requiring mechanical ventilation. Cochrane Database Syst Rev, 2016. 8(1): p. CD009946. 10.1002/14651858.CD009946.pub2.
  10. Cox J. Pressure ulcer development and vasopressor agents in adult critical care patients: a literature review. Ostomy Wound Manage., 2013. 59(4): p. 50-4, 56-60.
  11. Karayurt O, et al. The incidence of pressure ulcer in patients on mechanical ventilation andeffects of selected risk factors on pressure ulcer development. Turk J Med Sci, 2016. 46(5): p. 1314-1322. 10.3906/sag-1504-139.
  12. Metheny NA. Frantz RA. Head-of-bed elevation in critically ill patients: a review. Crit Care Nurse, 2013. 33(3): p. 53-66. 10.4037/ccn2013456.
  13. The National Pressure Ulcer Advisory Panel. National Pressure Ulcer Advisory Panel (NPUAP) announces a change in terminology from pressure ulcer to pressure injury and updates the stages of pressure injury. April 13, 2016 [cited 2018 Aug 30]; Available from: http://www.npuap.org/national-pressure-ulcer-advisory-panel-npuap-announces-a-change-in-terminology-from-pressure-ulcer-to-pressure-injury-and-updates-the-stages-of-pressure-injury/.
  14. Vangilder C, et al. Results of the 2008 - 2009 international pressure ulcer prevalence survey and a 3-year, acute care, unit-specific analysis. Ostomy Wound Manage., 2009. 55(11): p. 39-45.
  15. The British Columbia Provincial Interprofessional Skin & Wound Committee. Guideline: Prevention of Pressure Injury in Adults & Children. 2018 [cited 2018 Aug 28]; Available from: https://www.clwk.ca/buddydrive/file/guideline-prevention-of-pressure-injuries-2017-november-final/.
  16. Kaewprag P, et al. Predictive models for pressure ulcers from intensive care unit electronic health records using Bayesian networks. BMC Med Inform Decis Mak, 2017. 17(Suppl 2): p. 65. 10.1186/s12911-017-0471-z.
  17. Grap M., et al. Effect of backrest elevation on the development of ventilator-associated pneumonia. Am J Crit Care, 2005. 14(4): p. 325-32.
  18. Johnson K, Meyenburg T. Physiological rationale and current evidence for therapeutic positioning of critically ill patients. AACN Adv Crit Care, 2009. 20(3): p. 228-40. 10.1097/NCI.0b013e3181add8db.