Controlled Clinical Trial: Ventilator Associated Pneumonia

Ventilator Associated Pneumonia (VAP) is pneumonia that develops forty-eight hours or more after intubation. When a patient has to be mechanically ventilated with an endotracheal or tracheostomy tube, they are at a higher risk of developing pneumonia because the tube bypasses their normal upper airway defenses. Their underlying disease process, depressed immune system, immobility, and poor nutritional state also place them at an increased risk. Bacteria can colonize the tube due to dirty respiratory equipment, improper hand hygiene, breaking sterility when performing care, and inability of patient to cough and clear secretions leading to colonization in the lung and pneumonia. When a patient has VAP, they present in much the same way a patient with Community-Acquired-Pneumonia would: fever, increased white blood cell count, crackles on auscultation, purulent sputum, and abnormalities on X-ray. (Lewis et al., 2017)

In the article, “Impact of Care Program on Ventilator-Associated Pneumonia Incidence: A Clinical Trial,” Yaghoubinia, Tabatabaei, Jahantigh, and Mohammadi aimed to determine the impact of a care program on VAP incidence in an intensive care unit. This was a single-blinded controlled clinical trial of seventy patients hospitalized in two hospitals in Zahedan, Iran over the course of three days. Convenience sampling was used in that the patients were selected simply because they were on the unit and intubated at the time the study was done. Thirty-five were randomly assigned to the control group while the other thirty-five were part of the intervention group. The care program (intervention) consisted of four parts along with standard care. First, the head of the bed was elevated at least thirty degrees. Second, The daily gastric residual volume was assessed at both 10 o’clock in the morning and 10 o’clock at night and gastric lavage was performed. If the refluxed fluid was more than two hundred milliliters, the next gavage was delayed according to policy. The third step was an abdominal massage performed at 10:30 a.m. and 10:30 p.m. to promote peristalsis and digestion, which would in turn, decrease aspiration risk. The final step was mouth care, which was performed one hour after gavage and included swabbing the mouth with chlorhexidine rinse. Standard care, performed on both the intervention and control group, included suctioning and mouth care every two hours. The study findings were both clinically and statistically significant.

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