Abstract
The ventilator bundle consists of multiple methods to reduce ventilator-associated pneumonia (VAP) rates in Intensive Care Units (ICU). The aim of the study was to evaluate how the continuous automatic pressure control in tapered cuffs of endotracheal/tracheostomy tubes applied along with continuous automatic subglottic secretion suction affect the incidence of VAP. In the prospective cohort (n = 198), the standard VAP bundle was modified by continuous automatic pressure control in taper-shaped cuff of endotracheal/tracheostomy tubes and subglottic secretion suction. VAP incidence, time to VAP onset, invasive mechanical ventilation days/free days, length of ICU stay, ICU mortality, and multidrug-resistant bacteria were assessed and compared to the retrospective cohort (n = 173) with the standard bundle (intermittent cuff pressure of standard cuff, lack of subglottic secretion suction). A smaller incidence of VAP (9.6% vs. 19.1%) and early onset VAP (1.5% vs. 8.1%) was found in the prospective compared to the retrospective cohort (p < 0.01). Patients in the prospective cohort were less likely to develop VAP (RR = 0.50; 95% CI: 0.29 to 0.85) and early-onset VAP (RR = 0.19; 95% CI: 0.05 to 0.64) and had longer time to onset VAP (median 9 vs. 5 days; p = 0.03). There was no significant difference (p > 0.05) between both cohorts in terms of invasive mechanical ventilation days/free days, length of ICU stay, ICU mortality and multidrug-resistant bacteria. Modification of the bundle for prevention of VAP can reduce early-onset VAP and total incidence of VAP and delay the time of VAP occurrence.
Highlights
In a large number of cases, therapy in Intensive Care Units (ICU) is associated with opening the airways with an endotracheal or tracheostomy tube and supporting breathing with a ventilator [1], which promotes lower respiratory tract infections
The prevalence of Ventilatorassociated pneumonia (VAP) depends on the diagnostic criteria used [4], the geographic region, and the type of hospital [5,6]; this ranges in adult patients from 4% to 42%
The aim of the study was to evaluate how the continuous automatic pressure control in tapered cuffs of endotracheal/tracheostomy tubes applied along with continuous automatic subglottic secretion suction affect the incidence of VAP
Summary
In a large number of cases, therapy in Intensive Care Units (ICU) is associated with opening the airways with an endotracheal or tracheostomy tube and supporting breathing with a ventilator [1], which promotes lower respiratory tract infections. Ventilatorassociated pneumonia (VAP) is one of the most serious types of these infections. It is defined as symptoms of pneumonia occurring 48 h after the onset of artificial airway and mechanical ventilation [2,3]. The prevalence of VAP depends on the diagnostic criteria used [4], the geographic region, and the type of hospital [5,6]; this ranges in adult patients from 4% to 42%. 538,600 patients from 14 Asian countries, the incidence density of VAP/1000 ventilator days ranged from 9 to 18.5. In Poland, the incidence of VAP, according to data collected in 2013–2017, was 8–10%, and the incidence density of VAP per 1000 ventilator days was
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