Effectiveness of Nursing Strategies on Risk for Pneumonia Among Patients Connected to Mechanical Ventilator in Intensive Care Unit

Gopinath Duraivelu; Porkodi Arjunan; Kavitha Ramanathan; Shenbaga Sundaram Subramanian; Manjula Annamalai; Poongodi Ramalingam

doi:10.52756/ijerr.2024.v38.015

Authors

Gopinath Duraivelu Sri Ramachandra Faculty of Nursing, Sri Ramachandra Institute of Higher Education & Research (DU), Chennai, Tamil Nadu, India https://orcid.org/0009-0002-0650-7331
Porkodi Arjunan Sri Ramachandra Faculty of Nursing, Sri Ramachandra Institute of Higher Education & Research (DU), Chennai, Tamil Nadu, India https://orcid.org/0000-0003-0589-8000
Kavitha Ramanathan Sri Ramachandra Faculty of Nursing, Sri Ramachandra Institute of Higher Education & Research (DU), Chennai, Tamil Nadu, India https://orcid.org/0000-0002-5437-605X
Shenbaga Sundaram Subramanian Chettinad School of Physiotherapy (CSP), Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Kelambakkam, Tamil Nadu 603103, India https://orcid.org/0000-0002-6150-0928
Manjula Annamalai Sri Ramachandra Faculty of Nursing, Sri Ramachandra Institute of Higher Education & Research (DU), Chennai, Tamil Nadu, India https://orcid.org/0000-0002-7820-1801
Poongodi Ramalingam Sri Ramachandra Faculty of Nursing, Sri Ramachandra Institute of Higher Education & Research (DU), Chennai, Tamil Nadu, India https://orcid.org/0000-0001-8876-7676

DOI:

https://doi.org/10.52756/ijerr.2024.v38.015

Keywords:

Nursing strategies, Ventilator associated pneumonia, Mechanical ventilator, ICU

Abstract

It has been reported that the incidence of nosocomial infections in the ICU is about 2–5 times higher than in the general in-patient hospital population. The study's objective was to evaluate the effectiveness of Nursing Strategies on Risk for Pneumonia among Patients connected to Mechanical Ventilator in Intensive Care Unit. The study adopted randomized controlled trial. Forty patients were enrolled in the study after screening using CPIS scale. If the score <6 the patients were included in the study and eligibility criteria were age between 25 to 60 years, duration of ventilator 48 hours and medical patients with respiratory, renal, MODS, and sepsis diagnosis. Patients subjected to surgery and connected with non-invasive ventilation were excluded from the study. Standardized questionnaire such as demographic variables, clinical variables, and Clinical Pulmonary Infection Scoring (CPIS). The data was analyzed using descriptive statistics, independent ‘t’ test, paired t test and ANOVA were used to analyze the data. Seven (35%) of them were in the age group of 51-60 years in the study group, whereas six (30%) of the patients were in the age group of 61-70 years in the control group. 12(60%) of the patients were male and eight (40%) of them were female in the study group and 10(50%) of patients were male and female respectively in the control group. Regarding mode of ventilation, 12(50%) and six (30%) of patients ventilator setting were CMV and ASV respectively, in the study group, whereas seven (35%) and six (30%) of patients ventilator settings were ASV and CMV respectively in the control group. The pretest CPIS mean score was 4.40 with a standard deviation of 0.59 and the posttest III mean value was 2.60 with a standard deviation of 0.58 and the mean difference was 1.80 between the pretest and the posttest III, which was statistically significant at p<0.001 in the study group. Nursing strategies such as demand suctioning, second hourly position change, changing ventilator flow sensor every 72 hours, and oral care every fourth hour with chlorhexidine help reduce ventilator-associated pneumonia.

References

Alp, E., & Voss, A. (2006). Ventilator associated pneumonia and infection control. Annals of clinical microbiology and antimicrobials, 5, 1-11.

Baker, A. M., Meredith, J. W., & Haponik, E. F. (1996). Pneumonia in intubated trauma patients. Microbiology and outcomes. American Journal of Respiratory and Critical Care Medicine, 153(1), 343-349.

Da Silva, P. S. L., De Aguiar, V. E., De Carvalho, W. B., & Machado Fonseca, M. C. (2014). Value of clinical pulmonary infection score in critically ill children as a surrogate for diagnosis of ventilator-associated pneumonia. Journal of Critical Care, 29(4), 545–550. https://doi.org/10.1016/j.jcrc.2014.01.010

Febbo, J. A., & Ketai, L. (2021). Emerging Pulmonary Infections in Clinical Practice. Advances in Clinical Radiology, 3, 103–124. https://doi.org/10.1016/j.yacr.2021.04.010

Ghezeljeh, T. N., Kalhor, L., Moghadam, O. M., Lahiji, M. N., & Haghani, H. (2017). The Comparison of the Effect of the Head of Bed Elevation to 30 and 45 Degreess on the Incidence of Ventilator Associated Pneumonia and the Risk for Pressure Ulcers: A Controlled Randomized Clinical Trial. Iranian Red Crescent Medical Journal, 19(7).

Grap, M. J., Munro, C. L., Hamilton, V. A., Elswick, R. K., Sessler, C. N., & Ward, K. R. (2011). Early, single chlorhexidine application reduces ventilator-associated pneumonia in trauma patients. Heart & Lung, 40(5), e115–e122. https://doi.org/10.1016/j.hrtlng.2011.01.006

Güner, C.K., & Kutlutürkan, S. (2022). Role of head-of-bed elevation in preventing ventilator-associated pneumonia bed elevation and pneumonia. Nurs. Crit. Care, 27(5), 635–45

Havlucu, Y., Coskun, A., Cam, S., Gonen, N., Goktalay, T., Celik, P., & Yorgancioglu, A. (2012). Relation Between Clinical Pulmonary Infection Score, C-Reactive Protein, and Procalcitonin and Mortality in Patients with Hospital Acquired Pneumonia. Chest, 142(4), 224A. https://doi.org/10.1378/chest.1364855

Izadi, M., Bagheri, M., Bahrami Far, A., Bagheri-baghdasht, M. S., Ghasemzadeh, G., Sureda, A., & Soodmand, M. (2023). Reduce the risk of ventilator-associated pneumonia in ICU patients by Ozonated water mouthwash: A double-blind randomized clinical trial. American Journal of Infection Control, 51(7), 779–785. https://doi.org/10.1016/j.ajic.2022.10.015

Izadi, M., Bagheri, M., Far, A. B., Bagheri-baghdasht, M. S., Ghasemzadeh, G., Sureda, A., Simonetti, V., & Soodmand, M. (2024). Prevention of ventilator-associated pneumonia in ICU patients by Ozonated water mouthwash: A double-blind randomized clinical trial [Preprint]. Preprints. https://doi.org/10.22541/au.170668060.05719805/v1

Jahanshir, M., Nobahar, M., Ghorbani, R., & Malek, F. (2023). Effect of clove mouthwash on the incidence of ventilator-associated pneumonia in intensive care unit patients: a comparative randomized triple-blind clinical trial. Clinical Oral Investigations, pp.1-12.

Junaidy, S. R., Wilaiwan, M., Rajkumari, J., & Waraporn, K. (2018). Implementation of innovative nursing care program for relieving discomfort in mechanically ventilated patients: an exemplar in practice. The Malaysian Journal of Nursing (MJN), 9(3), 34-44.

Khan, H. A., Baig, F. K., & Mehboob, R. (2017). Nosocomial infections: Epidemiology, prevention, control and surveillance. Asian Pacific Journal of Tropical Biomedicine, 7(5), 478-482.

Klompas, M., Branson, R., Cawcutt, K., Crist, M., Eichenwald, E. C., Greene, L. R., ... & Berenholtz, S. M. (2022). Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infection Control & Hospital Epidemiology, 43(6), 687-713.

Lauzier, F., Ruest, A., Cook, D., Dodek, P., Albert, M., Shorr, A. F., Day, A., Jiang, X., & Heyland, D. (2008). The value of pretest probability and modified clinical pulmonary infection score to diagnose ventilator-associated pneumonia. Journal of Critical Care, 23(1), 50–57. https://doi.org/10.1016/j.jcrc.2008.01.006

Li Y, Liu C, Xiao W, Song T, Wang S (2020) Incidence, risk factors, and outcomes of ventilator-associated pneumonia in traumatic brain injury: a meta-analysis. Neurocrit Care, 32(1), 272– 285. https://doi.org/10.1007/s12028-019-00773-w

Ling, M. L., Apisarnthanarak, A., & Madriaga, G. (2015). The burden of healthcare-associated infections in Southeast Asia: a systematic literature review and meta-analysis. Clinical Infectious Diseases, 60(11), 1690-1699.

Love, J. D., & Kao, L. S. (2013). Commentary: Empiric antibiotics pending bronchoalveolar lavage data in patients without pneumonia significantly alters the flora but not the resistance profile if a subsequent pneumonia develops. Journal of Surgical Research, 185(1), e5–e7. https://doi.org/10.1016/j.jss.2012.09.025

Luo, W., Xing, R., & Wang, C. (2021). The effect of ventilator-associated pneumonia on the prognosis of intensive care unit patients within 90 days and 180 days. BMC Infectious Diseases, 21(1), 1-7.

Mahmoodpoor, A., Hamishehkar, H., Hamidi, M., Shadvar, K., Sanaie, S., Golzari, S. E., Khan, Z. H., & Nader, N. D. (2017). A prospective randomized trial of tapered-cuff endotracheal tubes with intermittent subglottic suctioning in preventing ventilator-associated pneumonia in critically ill patients. Journal of Critical Care, 38, 152–156. https://doi.org/10.1016/j.jcrc.2016.11.007

Manchal, N., Siriwardena, M., Hay, K., Shekar, K., & McNamara, J. F. (2021). Assessment of the Clinical Pulmonary Infection Scores for prediction of ventilator associated pneumonia in patients with out of hospital cardiac arrest. Infection, Disease & Health, 26(1), 48–54. https://doi.org/10.1016/j.idh.2020.09.001

Niederman, M. S., & Soulountsi, V. (2011). De-Escalation Therapy: Is It Valuable for the Management of Ventilator-Associated Pneumonia? Clinics in Chest Medicine, 32(3), 517–534. https://doi.org/10.1016/j.ccm.2011.05.009

Noraini, H., & Wahab, M. (2022). Nursing practices of implementing early mobilisation on patients with mechanical ventilators in the intensive care unit. The Malaysian Journal of Nursing (MJN), 13(3), 99-105. https://doi.org/10.31674/mjn.2022.v13i03.014

Nusrat, T., Akter, N., Rahman, N. A. A., Godman, B., D. Rozario, D. T., & Haque, M. (2020). Antibiotic resistance and sensitivity pattern of Metallo-β-Lactamase Producing Gram-Negative Bacilli in ventilator-associated pneumonia in the intensive care unit of a public medical school hospital in Bangladesh. Hospital Practice, 48(3), 128-136.

Richards, M. J., Edwards, J. R., Culver, D. H., & Gaynes, R. P. (1999). Nosocomial infections in medical intensive care units in the United States. Critical Care Medicine, 27(5), 887-892.

Safavi, A., Molavynejad, S., Rashidi, M., Asadizaker, M., & Maraghi, E. (2023). The effect of an infection control guideline on the incidence of ventilator-associated pneumonia in patients admitted to the intensive care units. BMC Infectious Diseases, 23(1), 1-7.

Safiriyu, I., Fatuyi, M., Mehta, A., Naser, A., Alexander, E., Vovan, H., Shamaki, G. R., & Bob-Manuel, T. (2023). Impact of COVID-19 Infection on the Clinical Outcomes of Pulmonary Embolism Hospitalizations: A Nationwide Analysis. Current Problems in Cardiology, 48(7), 101669. https://doi.org/10.1016/j.cpcardiol.2023.101669

Shen, B., Hoshmand-Kochi, M., Abbasi, A., Glass, S., Jiang, Z., Singer, A. J., Thode, H. C., Li, H., Hou, W., & Duong, T. Q. (2021). Initial chest radiograph scores inform COVID-19 status, intensive care unit admission and need for mechanical ventilation. Clinical Radiology, 76(6), 473.e1-473.e7. https://doi.org/10.1016/j.crad.2021.02.005

Sungurlu, S., & Balk, R. A. (2024). The Role of Biomarkers in the Diagnosis and Management of Pneumonia. Infectious Disease Clinics of North America, 38(1), 35–49. https://doi.org/10.1016/j.idc.2023.12.005

Teng, G., Wang, N., Nie, X., Zhang, L., & Liu, H. (2022). Analysis of risk factors for early-onset ventilator-associated pneumonia in a neurosurgical intensive care unit. BMC Infectious Diseases, 22(1), 66.

Vanhems, P., Bénet, T., Voirin, N., Januel, J. M., Lepape, A., Allaouchiche, B., ... & Study Group philippe. vanhems@ chu-lyon. fr. (2011). Early-onset ventilator-associated pneumonia incidence in intensive care units: a surveillance-based study. BMC Infectious Diseases, 11, 1-6.

Wu, D., Wu, C., Zhang, S., & Zhong, Y. (2019). Risk factors of ventilator-associated pneumonia in critically III patients. Frontiers in Pharmacology, 10, 482.