Prevention Of Pneumonia In Patients Research Articles

Stroke Phase Is Essential for Pneumonia in Dysphagia Patients After Cerebral Infarction.

The risk of pneumonia increases after stroke, especially in poststroke dysphagia patients. Propensity score matching (PSM) is a statistical method in SPSS, which can be used to balance the difference between the 2 groups of known factors. Nasogastric tube feeding is an important factor of stroke-associated pneumonia. However, few studies have used PSM to eliminate the effect of confounding factor. Our research was a retrospective case-control study. Retrospective review of the patient database between December 1, 2019, and June 30, 2022, to identify consecutive dysphagia patients after cerebral infarction during hospitalization. An 1:1 PSM in SPSS 25.0 was used to balance nasogastric tube feeding between patients with and without pneumonia. The characteristics of these 2 groups were analyzed. Univariate and binary logistic regression analyses were used to screen the risk factors of dysphagia after cerebral infarction. After 1:1 PSM, 198 subjects met our criteria and were included in the analysis. Age [odds ratio (OR)=1.047, 95% CI: 1.013-1.081, P=0.006], stroke phase (acute stroke) (OR=5.931, 95% CI: 1.133-31.054, P=0.035), admission National Institutes of Health Stroke Scale score (OR=1.058, 95% CI: 1.004-1.115, P=0.034), and length of hospital stay (OR=1.025, 95% CI: 1.001-1.049, P=0.042) had statistically significant correlation with pneumonia in patients with dysphagia after cerebral infarction. In clinical practice, for the prevention of pneumonia in patients with dysphagia after cerebral infarction, we should pay more attention to admission National Institutes of Health Stroke Scale score, age, and stroke phase, especially in acute cerebral infarction patients.

Bundle care - prevention of pneumonia in patients mechanically ventilated in COVID-19 pandemia - a challenge for patients and personnel safety

Intensive care units are characterized by the high risk of infections in patients. Pneumonia is one of the most common forms of infection with a high risk of death. Hence, to improve patient safety, specific packages of procedures, the so-called "bundle care," are recommended by experts in the field. The usage of selected protective procedures carries the risk of transmitting microbes from patients to staff, which in the case of pathogens such as SARS-CoV-2 can have serious health consequences for staff. Therefore, medical staff of intensive care units should strictly follow recommendation concerning healthcare workers safety and the rules of isolation, which in the current pandemic should be supplemented with specific elements. The paper presents an overview of the optimization of patient care and staff safety within the so-called "bundle care" in the COVID-19 pandemic. Med Pr. 2021;72(6):721-8.

Risk factors for postoperative pneumonia after general and digestive surgery: a retrospective single-center study.

Pneumonia is the second-most common complication in postoperative patients and is associated with significant morbidity and high costs of care. We aimed to determine the risk factors for pneumonia after general and digestive surgery. The medical records of 1,016 patients who underwent general and digestive surgery between January 2016 and March 2019 in our hospital were reviewed. Of the 1,016 patients, 67 (6.6%) developed postoperative pneumonia. The multivariate analysis showed that significant predictors of postoperative pneumonia were a poor Eastern Cooperative Oncology Group performance status (ECOG-PS), low forced vital capacity and low forced expiratory volume in one second in the spirometry test, malnutrition (low serum albumin levels and low controlling nutritional status scores and prognostic nutritional index [PNI] values), esophagectomy, upper gastrointestinal surgery, and nonlaparoscopic surgery. Of these factors, the combination of PNI and ECOG-PS clearly stratified patients into low-, intermediate-, and high-risk groups with respect to developing postoperative pneumonia (area under the curve: 0.709). Although postoperative pneumonia is associated with many clinical variables, active medical intervention for the prevention of pneumonia in patients with multiple risk factors can improve the postoperative course. In particular, perioperative nutritional care may prevent postoperative pneumonia in patients with malnutrition and a poor PS.

Investigating the Role of Subglottic Secretions Suctioning in the Prevention of ‎Ventilator Associated Pneumonia in Patients With Invasive Mechanical ‎Ventilation

BACKGROUND: development of ventilator associated pneumonia (VAP) leads to ‎prolonged hospital stay, increased health care cost, and mortality rates. Subglottic ‎secretion drainage through a dedicated endotracheal tube has been advocated as a mean ‎to decrease the incidence of VAP and thereby assisting in ‎the decrease of morbidity associated with invasive mechanical ventilation.‎
 
 OBJECTIVE: Investigate the role of subglottic secretion suctioning in the prevention of VAP in mechanically ventilated patients in intensive care unit.‎
 
 METHODS: A cross sectional study done in the intensive care unit of Ghazi Al-Hariri ‎hospital for surgical specialties in medical city complex, 30 patients who ‎are in need for invasive mechanical ventilation were intubated with endotracheal tube ‎that have special port for subglottic secretion suctioning. Daily monitoring of patients ‎clinical and radiological data to detect features of VAP was ‎done, and if there was a suspicion of pneumonia, culture for tracheal aspirate performed ‎to confirm diagnosis.‎
 
 RESULTS: ‎Patient’s age was 37.1 ± ‎‎15.39 years, the highest proportion of study patients was found in ‎age group < 30 and ‎‎30–49 years (40% in ‎each group), most of the patients were males (70%) with a male to female ratio of ‎‎2.33:1‎‏, ‏Subglottic secretion suctioning lead to reduction in VAP by relative risk (95%CI) of ‏‎0.167 (0.045–0.559)‎‏, p-‏value = 0.001. ‏Twenty eight patients didn’t show any sign, symptoms ‎or radiological features suggesting a ‎diagnosis of pneumonia while two patients developed ‎features of pneumonia (suggestive signs and ‎symptoms, radiological features and ‎positive culture of tracheal aspirate).‎
 
 CONCLUSION: the use of endotracheal tube with subglottic ‎secretions suctioning can have a role in the prevention of VAP in mechanically ventilated patients.‎

Relationship between functional independence measure and geriatric nutritional risk index in pneumonia patients in long-term nursing care facilities.

The prevention of pneumonia is an urgent issue among Japanese older adults. However, little has been reported on the relationship between a Functional Independence Measure (FIM) and the Geriatric Nutrition Risk Index (GNRI) for the prevention of pneumonia in patients in long-term care facilities in Japan. We aimed to clarify the relevance of FIM and GNRI for inpatients with and without pneumonia. We identified 233 patients who were hospitalized in our long-term nursing hospital from April 2012 to September 2013. We compared differences in FIM among GNRI classes for four groups: (i) pneumonia/high GNRI; (ii) pneumonia/low GNRI; (iii) no pneumonia/high GNRI; and (iv) no pneumonia/low GNRI. To assess the pneumonia predictors, we used a logistic regression for long-term nursing patients. Receiver operating characteristic analysis showed cut-off values and the area under the curve. A total of 88 (37.8%) of 233 inpatients had pneumonia. FIM of the pneumonia/low GNRI groups was significantly lower than that of the no pneumonia/high and low GNRI groups. Logistic regression showed that FIM (P<0.001; OR -1.035, 95% CI -1.019-1.051) and GNRI (P=0.017; OR -1.038, 95% CI -1.007-1.070) were predictors of pneumonia. The cut-off values for FIM and GNRI were 26.6 (P<0.001, the area under the curve 0.70) and 80.5 (P<0.001, the area under the curve 0.65), respectively. Low activity and malnutrition might lead to the development of pneumonia. FIM and GNRI are useful predictor tools that could help to prevent pneumonia in Japanese patients in long-term care facilities. Geriatr Gerontol Int 2017; 17: 1617-1622.

Interdiciplinares impactanto actions on prevention of ventilator-associated pneumonia in patients of trauma intensive care unit

Ventilator associated pneumonia is the most common among hospital infections, especially in intensive care unit patients Trauma. With the concern to improve the quality provided in assistance to patients on mechanical ventilation, intensive care created a multidisciplinary group to develop, evaluate and implement the necessary measures to prevent ventilator-associated pneumonia.

Prevention of Pneumocystis pneumonia in patients with inflammatory bowel disease based on the detection of Pneumocystis colonization

Prevention of Pneumocystis pneumonia in patients with inflammatory bowel disease based on the detection of Pneumocystis colonization

Angiotensin-converting enzyme inhibitor use and protection against pneumonia in patients with diabetes

Because of the high risk of pneumonia in patients with diabetes, we aimed to assess the effect of angiotensin-converting enzyme (ACE) inhibitor use on the occurrence of pneumonia in a general population of patients with diabetes. The study population comprised all patients in the UK General Practice Research Database who had a diagnosis of diabetes (both type 1 and type 2) between 1987 and 2001. Cases were defined as patients with a first diagnosis of pneumonia. For each case, up to four controls were matched by age, gender, practice, and index date. Patients were classified as current ACE inhibitor user when the index date was between the start and end date of ACE inhibitor therapy. Conditional logistic regression analysis was used to estimate the strength of the association between ACE inhibitor use and pneumonia risk. ACE inhibitors were used in 12.7% of 4719 cases and in 13.7% of 15,322 matched controls [crude odds ratio (OR)=0.92, 95% confidence interval (CI)=0.82-1.01]. After adjusting for confounding, ACE inhibitor therapy was associated with a significant reduction in pneumonia risk (adjusted OR=0.72, 95% CI=0.64-0.80). The protective association was consistent across different relevant subgroups with the strongest association in patients with a history of stroke. There was a significant dose-effect relationship (P for trend < 0.001). The use of ACE inhibitors is associated with a significant reduction in pneumonia risk and, apart from blood pressure-lowering properties, may be useful in the prevention of pneumonia in patients with diabetes.

Integrating Oral Care into a Process for Prevention of Pneumonia in Patients with Artificial Airways

ISSUE: In intensive care settings, effective oral care may be a lower priority due to the demand for more critical nursing skills. However, the impact for infections involving the respiratory tract, particularly for patients with artificial airways, can be significant. Bacterial colonization and the risk of introducing pathogens along the conduit of an endotracheal tube are significant risk factors for ventilator associated pneumonia. PROJECT: In May 2004, a task force consisting of Infection Control, Medical Pulmonary Intensive Care (MICU) and Surgical Trauma Intensive Care (STICU) nurses was charged with developing a process for effective oral care. Concurrently, the Infection Control department monitored ventilator associated pneumonia (VAP) rates. A product based on interval oral care was selected. A six-month trial was mandated by the hospital Value Analysis Committee. The task force designed a program with 4 components: hand hygiene, oral care, mobility and elevation of head of bed. The initiative was called “Our Goal is HOME,” an acronym from the components. Educational storyboards, data collection tools, written policy and procedure were developed, implemented and feedback provided. RESULTS: VAP rate in the STICU was reduced from 19 for Jan-Mar 2004 to a rate of 10 for Jan-Mar 2005. Jan-Dec 2004 had 31 VAPS, while Jan-Nov 2005 has seen 11 VAPs. As part of a quality improvement intitiative for this unit, this demonstrates a 65% reduction. This unit has continued to decrease VAPs, achieving a 5.4 rate. A cost of $560,000 has been avoided based on a published estimate of $40,000 per VAP. In MICU Jan-Mar 2004 the rate was 4.4, compared to 3.5 in Jan-Mar 2005. Jan-Dec 2004 had 5 VAPs, while Jan-Nov 2005 counted 2 VAPs with a cost avoidance of $120,000. Positive feedback from families and healthcare workers has been significant. LESSONS LEARNED: Daily and weekly data collection on intervention compliance was tedious and complicated. As a participant in the IHI Initiative for VAP prevention, monitoring components of the vent bundle has been added to our electonic pateint record. Oral care is included in our bundle components. Issues arose regarding disposal or reuse of pieces of the oral care kit left over at discharge or death. Discarding the product seems wasteful, however potential transmission of pathogens is a concern. A supply management process needs improvement. VAP rates were significantly impacted by a focused process for improving hand hygiene, oral care, mobility and head of bed elevation. Monitoring oral care regimen by use of a timed delivery system was the easiest component to monitor and the most significant process change of the study period.

Use of intravenous immunoglobulin in human disease: A review of evidence by members of the Primary Immunodeficiency Committee of the American Academy of Allergy, Asthma and Immunology

Human immunoglobulin prepared for intravenous administration (IGIV) has a number of important uses in the treatment of disease. Some of these are in diseases for which acceptable treatment alternatives do not exist. In this review we have evaluated the evidence underlying a wide variety of IGIV uses and make specific recommendations on the basis of these data. Given the potential risks and inherent scarcity of IGIV, careful consideration of the indications for and administration of IGIV is warranted.

Efficacy of intravenous immunoglobulin on the prevention of pneumonia in patients with agammaglobulinemia

Agammaglobulinemia is characterized by failure of B-cell differentiation (hypogammaglobulinemia) and increased susceptibility to bacterial infections. The present study was set up in order to evaluate the effectiveness of intravenous immunoglobulin (IVIG) treatment on the incidence of pneumonia in patients with agammaglobulinemia. We carried out chart reviews of 23 patients with agammaglobulinemia (mean age 11.5±5.4 years), who had been observed in a 22-year period (July 1981–January 2003) in Iran’s referral center for primary immunodeficiency disorders. Nineteen of these 23 (82.5%) had been infected with pneumonia at least once before receiving the immunoglobulin treatment and 11 of them had experienced multiple episodes. During treatment with γ-globulin – over a mean period of 6.8±4.1 years (range: 0.8–15.3 years) – the incidence of pneumonia requiring treatment or hospitalization decreased from 0.82 to 0.12 per patient per year ( P=0.006). During IVIG replacement, hospitalization due to pneumonia decreased from 0.58 to 0.05 per patient per year ( P=0.08) and the immunoglobulin G level (mean±S.D.) changed from 66.2±63.9 (range: 0–210 mg dl −1) to 552.4±199.1 (range: 136–942 mg dl −1) ( P<0.001). Treatment of agammaglobulinemia with IVIG significantly reduced the incidence of pneumonia and hospital admission. Intensive management and regular monitoring is required in order to fully prevent severe respiratory complications.