Chair of Internal Medicine, Faculty of Medicine, University of Maribor, Maribor, Slovenia.
Bosn J Basic Med Sci. 2018 Feb 20;18(1):105-109. doi: 10.17305/bjbms.2017.2278.
Ventilator-associated pneumonia (VAP) is a potentially preventable iatrogenic illness that may develop following mechanical ventilation. A bundle for the prevention of VAP consists of different measures which may vary between institutions, and may include: elevation of the head of the bed, oral care with chlorhexidine, subglottic suctioning, daily assessment for extubation and the need for proton-pump inhibitors, use of closed suction systems, and maintaining endotracheal cuff pressure at 25 cmH2O. Our aim was to determine the efficacy of a VAP prevention bundle, consisting of the above-mentioned measures, by evaluating the incidence of VAP before (no-VAP-B group) and after (VAP-B group) the introduction of the bundle. We retrospectively evaluated the data for patients who were mechanically ventilated with an endotracheal tube, in the period between 1 September and 31 December 2014 (no-VAP-B group, n = 55, 54.5% males, mean age 67.8 ± 14.5 years) and between 1 January to 30 April 2015 (VAP-B group, n = 74, 62.1% males, mean age 64.8 ± 13.7 years). There were no statistically significant differences between no-VAP-B and VAP-B groups in demographic data, intensive care unit (ICU) mortality, hospital mortality, duration of ICU treatment, and duration of mechanical ventilation. No significant differences in the rates of VAP and early VAP (onset ≤7 days after intubation) were found between no-VAP-B and VAP-B groups (41.8% versus 25.7%, p = 0.06 and 10.9% versus 12.2%, p > 0.99, respectively). However, a significant decrease in the late VAP (onset >8 days after intubation) was found in VAP-B group compared to no-VAP-B group (13.5% versus 30.9%, p = 0.027). Overall, our results support the use of VAP prevention bundle in clinical practice.
呼吸机相关性肺炎（VAP）是一种潜在可预防的医源性疾病，可能在机械通气后发生。VAP 预防包由不同的措施组成，这些措施在不同的机构之间可能有所不同，可能包括：床头抬高、氯己定口腔护理、声门下吸引、每日评估拔管和质子泵抑制剂的需求、使用密闭式吸痰系统以及将气管内套囊压力维持在 25cmH2O。我们的目的是通过评估预防包引入前后（无 VAP-B 组和 VAP-B 组）呼吸机相关性肺炎的发生率来确定 VAP 预防包的疗效，该预防包由上述措施组成。我们回顾性评估了 2014 年 9 月 1 日至 12 月 31 日（无 VAP-B 组，n=55，男性 54.5%，平均年龄 67.8±14.5 岁）和 2015 年 1 月 1 日至 4 月 30 日（VAP-B 组，n=74，男性 62.1%，平均年龄 64.8±13.7 岁）期间接受气管内插管机械通气的患者的数据。无 VAP-B 组和 VAP-B 组在人口统计学数据、重症监护病房（ICU）死亡率、医院死亡率、ICU 治疗时间和机械通气时间方面无统计学差异。无 VAP-B 组和 VAP-B 组之间呼吸机相关性肺炎和早期呼吸机相关性肺炎（发病≤插管后 7 天）的发生率无显著差异（41.8%与 25.7%，p=0.06；10.9%与 12.2%，p>0.99）。然而，与无 VAP-B 组相比，VAP-B 组中晚期呼吸机相关性肺炎（发病>插管后 8 天）的发生率显著降低（13.5%与 30.9%，p=0.027）。总的来说，我们的结果支持在临床实践中使用 VAP 预防包。
