ReviewIntubation-associated pneumonia: An integrative review
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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Cited by (22)
Trends in the proportion of resistant bacteria involved in ventilator-associated pneumonia as the first hospital-acquired infection in intensive care units between 2003 and 2016 in Lyon, France
2021, American Journal of Infection ControlCitation Excerpt :In this study, the patients were intubated on the first day of hospitalization and not covered by antibiotic on admission, suggesting these two factors could accelerate the occurrence of VAP related to microorganisms from a patient's oropharynx flora. The likelihood of colonization with MDROs from the community would therefore appear to be reasonable in early-onset VAP (with onset up to 4 d following intubation).5,6 According to some authors, bacteria isolated in late-onset VAP (starting at least 5 d after intubation) are more frequently MDROs and could be related to patient colonization or microbial ecology of ICU and antibiotic selection pressure.5–8
Ventilation bundle compliance in two Australian intensive care units: An observational study
2021, Australian Critical CareCitation Excerpt :VAEs are specific complications of mechanical ventilation that may develop if a patient is mechanically ventilated for more than 48 h.13 These complications lead to a prolonged hospital stay, lead to increased hospital costs, and are associated with doubling the risk of death compared with patients without the complications.14–16 Despite focused efforts for more than a decade to reduce morbidity and mortality among ventilated patients, VAEs remain a significant healthcare challenge.17 Between 5.8 and 16 events per 1000 mechanical ventilation days have been reported across several countries internationally.16,18
Nurses’ knowledge, experience and self-reported adherence to evidence-based guidelines for prevention of ventilator-associated events: A national online survey
2020, Intensive and Critical Care NursingCitation Excerpt :One comparative study Elliott et al. (2015) examined VAP rates using a consensus checklist versus physician assessment and found rates ranged from 25.9% to 26.7% per 1000 mechanical ventilation days respectively. These VAP rates are similar to those reported worldwide and VAP is reported to be the most common healthcare associated infection worldwide (Sousa et al., 2018). Despite this, the lack of agreement regarding VAP diagnosis may have led to limited Australian studies on VAP.
Intensive care nurses fail to translate knowledge and skills into practice – A mixed-methods study on perceptions of oral care
2019, Intensive and Critical Care NursingCitation Excerpt :Oral care reduces bacterial colonisation in the oropharyngeal cavity (Cecona et al., 2010) and might prevent adverse events such as deterioration in oral health (Terezakis et al., 2011) and respiratory infections (Hua et al., 2016). Intubation-associated pneumonia is considered the leading healthcare-associated infection cause of mortality in ICUs (Sousa et al., 2018) and is defined as a pneumonia occurring 48 hours or more after intubation, even if only intermittently (The European Centers for Disease Control and Prevention, 2010). The provision of oral care is complex and multifaceted (Dale et al., 2013) and depends on different external objective care conditions such as guidelines/protocols (Cutler and Sluman, 2014; El-Soussi and Asfour, 2017; Prendergast et al., 2013), documentation (Goss et al., 2011; Inan and Dinç, 2013) and the availability of equipment and supplies (Cutler and Sluman, 2014; Hua et al., 2016; Prendergast et al., 2013).
High rates of methicillin-resistant Staphylococcus aureus colonisation in a Brazilian Intensive Care Unit
2018, Intensive and Critical Care Nursing