Review
Intubation-associated pneumonia: An integrative review

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Abstract

Objective

This article aims to characterise intubation-associated pneumonia regarding its diagnosis, causes, risk factors, consequences and incidence.

Research methodology

Integrative literature review using database Pubmed and B-on and webpages of organisations dedicated to this area of study.

Setting

The research took place between May and July 2015. After selection of the articles, according to established criteria, their quality was assessed and 17 documents were included.

Results

Evidence has demonstrated that intubation associated pneumonia has a multifactorial aetiology and one of its main causes is micro-aspiration of gastric and oropharynx contents. Risk factors can be internal or external. The diagnostic criteria are based on clinical, radiological and microbiological data, established by several organisations, including the European Centres for Disease Control and Prevention, which are, however, still not accurate. In recent years, there has been a downward trend in the incidence in Europe. Nevertheless, it continues to have significant economic impact, as well as affecting health and human lives.

Conclusions

Several European countries are committed to addressing this phenomenon through infection control and microbial resistance programmes; however there is a much to be done in order to minimise its effects. The lack of consensus in the literature regarding diagnosis criteria, risk factors and incidence rates is a limitation of this study.

Introduction

Intubation-associated pneumonia (IAP) is one aspect of a major problem, healthcare associated infections (HCAI), which health systems are facing worldwide. Intubation-associated pneumonia is defined by The European Centers for Disease Control and Prevention (ECDC), as pneumonia occurring 48 hours or more after patients have been subjected to an invasive respiratory device, even if only intermittently, preceding the onset of infection (ECDC, 2010).

It is known that new advances in health and technology have led to an improved prognosis in the treatment of numerous diseases. These advances, however, have led to increased costs, including those associated with the use of invasive techniques involving an increased risk of infection. These and other factors establish HCAIs as the most frequent complications in hospitalisation, and IAP as the most frequent HCAI in the intensive care unit (Pina et al., 2010).

Section snippets

Background and significance

The concept of (HCAI) also referred to as “nosocomial” or hospital infection, has been repeatedly redefined over the years. Healthcare associated infection is currently defined by the World Health Organisation (WHO) as “an infection occurring in a patient during the process of care in a hospital or other health care facility which was not present or incubating at the time of admission. Healthcare associated infections can affect patients in any type of setting where they receive care and can

Method

The methodology adopted was an integrative literature review. The review was conducted between May and July 2015, using Pubmed and B-on databases, WHO, ECDC, Centers for Disease Control and Prevention (CDC) and Direção-Geral da Saúde (the Portuguese Directorate-General of Health − DGS) webpages. The literature search was conducted using the Medical Subject Headings terms “intubation, ‘intratracheal’, “pneumonia” and “pneumonia, ventilator-associated”. To increase the precision and accuracy of

Results

A total of seventeen studies were included: three integrative literature reviews, one systematic literature review, one prospective randomised controlled trial (RCT), two retrospective descriptive studies, one retrospective observational cohort study, one prospective cohort study, four Guidelines and four epidemic reports. Data were compiled on five key areas: causes, risk factors, diagnosis, incidence and consequences of IAP, along with the main conclusions of the studies (Table 1).

Causes of

Causes

There is a lack of consensus regarding the distinction between early and late-onset IAP, yet most authors consider early-onset IAP to occur immediately after 96 h after intubation (Pina et al., 2004). This type of pneumonia is often the consequence of intubation aspiration, and its infectious agents are microorganisms present in patient́s indigenous flora, however it may be caused by hospital microorganisms if the patient has already been admitted at the time of intubation. Late-onset IAP occurs

Facing the problem

European countries have been developing set efforts against HCAI since 1994 with the creation of Hospitals in Europe Link for Infection Control through Surveillance (HELICS). This organisation aims to monitor HCAI in European hospitals and seek joint solutions to indentified problems (Mertens et al., 1996). Along with ECDC and other organizations, HELICS was later integrated into the Improving Patient Safety in Europe (IPSE) network. In 2004 the European Commission set out in its strategic plan

Conclusion

Intubation-associated pneumonia has a multifactorial aetiology and can be due to lower airway contamination, material colonisation or, most frequently, to the micro-aspiration of oropharynx colonisation agents. Risk factors are not consensual, and include age, existence of concomitant serious illness, depression of consciousness, heart or lung disease associated, post-operative thoracoabdominal surgery, diseases that affect gastrointestinal motility or gastric emptying, prior administration of

Formatting of funding sources

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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