Recent studies have shown that educational interventions for ventilator-associated pneumonia (VAP) prevention may result in positive outcomes in intensive care units. However, other studies investigating this kind of intervention have produced inconsistent results. Thus this paper reports a protocol for systematic review and planned meta-analysis to investigate the association of instituted VAP educational interventions with clinician learning and patient outcomes. In this review, the authors will identify relevant citations from electronic databases, reference lists, and other sources; screen articles against predetermined eligibility criteria; appraise each study using the Cochrane Collaboration’s risk of bias assessment tools and combine acquired evidence using the meta-analytic approach. The results of this review are crucial to assist clinicians and policy-makers in making well-informed decisions regarding VAP prevention practices for mechanically ventilated patients. This review protocol followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 guidelines and was registered with PROSPERO as CRD42016051561.
Pneumonia, Ventilator-Associated

BACKGROUND: Pneumonia is a frequent complication in patients undergoing mechanical ventilation. Quantitative culture of protected specimen brush(PSB) have shown satisfactory diagnostic accuracy for the diagnosis of ventilator-associated pneumonia. However PSB method is invasive, expensive, and require a bronchoscopic procedure. But endotracheal aspiration(EA) is simple and less expensive. The purpose of our study was to investigate the diagnosic value of EA quantitative cultures. METHOD: We studied 15 cases of ventilator-associated pneumonia(for >72h of mechanical ventilation) patients. Patients were divided into two diagnostic categories. Group I was the patients who were suspicious of clinical pneumonia, Group II was the patients for control. The obtained samples by EA and PSB were homogenized for quantitative culture with a calibrated loop method in all patients. RESULT: Using 103cfu/ml, 105cfu/ml as threshold in quantitative culture of PSB, EA respectively, we found that EA quantitative cultures represented a relatively sentive(70%) and relatively specific (60%) method to diagnose the ventilator-associated pneumonia. CONCLUSION: Although EA quantitative cultures are less specific than PSB for diagnosing ventilator-associated pneumonia. EA quantitative cultures correlated with PSB quantitative culture in patients with clinical pneumonia and may be used to treat these patients when bronchoscopic procedures are not available.
Diagnosis ; Humans ; Pneumonia ; Pneumonia, Ventilator-Associated* ; Respiration, Artificial

Pneumonia is the cause of significant morbidity and mortality, despite advances in diagnosis and antibacterial treatment. Pneumonia is often misdiagnosed and mistreated up until recently. Recent classification of pneumonia consists of community-acquired pneumonia, health care-associated pneumonia, hospital-acquired pneumonia, and ventilator-associated pneumonia. The etiology, risk factors, and treatment are different among them. This article briefly introduces new concepts and ideas in biomarkers, diagnosis, treatment, prognosis, and prevention of pneumonia during the past 2 years. One of the most frequent subjects of recent papers was those about pandemic H1N1 in 2009.
Biomarkers ; Pandemics ; Pneumonia ; Pneumonia, Ventilator-Associated ; Prognosis ; Risk Factors

BACKGROUND: Pneumonia continues to be the most common major infection in trauma patients. Despite the advances in prevention, diagnosis, and treatment for pneumonia, it remains a major cause of morbidity and mortality. The aim of this retrospective study is to identify the risk factors and clinical features of ventilator-associated pneumonia among chest trauma patients. MATERIAL AND METHOD: The study population consisted of 78 mechanically ventilated patients admitted to the ICU of Chonnam National University Hospital between January, 2001, and December, 2006. The patients were divided into two groups: those with pneumonia (Group I) and without pneumonia (Group II). Clinical predictors of the occurrence and mortality for ventilator associated pneumonia were analyzed. RESULT: There were 57 men and 21 women, with a mean age of 48.3+/-19.9 years. Almost half of the patients, 48.7% (38 of 78), had pneumonia. The mortality rate was 21.0% (8 of 38) in Group I and 2.5% (1 of 40) in Group II. The predictors of ventilator-associated pneumonia were the duration of mechanical ventilation (17.4 days vs 6.5 days, p<0.001), the mean stay in the ICU (21.7 days vs 9.7 days, p<0.001), the use of inotropics due to hemodynamic instability (63.1% vs 25.0%, p=0.001), and the serum level of CRP (11.3+/-7.8 vs 6.4+/-7.3, p= 0.006). CONCLUSION: Posttraumatic ventilator-associated pneumonia was significantly related with the duration of mechanical ventilation, the mean stay in ICU, and the use of inotropics due to hemodynamic instability. The serum level of CRP at admission was higher in the pneumonia group. Morbidity and mortality can be reduced by early identification of predictive factors for developing pneumonia in chest trauma patients.
Female ; Hemodynamics ; Humans ; Male ; Pneumonia ; Pneumonia, Ventilator-Associated ; Respiration, Artificial ; Retrospective Studies ; Risk Factors ; Thorax

Mechanical ventilation is currently an indispensable element within a hospital's intensive care unit (ICU). Regrettably, mechanical ventilation is also strongly associated with the risk of contracting ventilator-associated pneumonia (VAP), which is one of the most common causes of mortality and morbidity within the ICU, and has been for many years. The incidence of VAP has decreased in the last 10 years, from 14 to 9-10 cases per 1,000 days of mechanical ventilation. This has been an important achievement; however, hospital-acquired pneumonia and VAP still carry very high rates of morbidity and mortality, not to mention high financial costs as well. This comprehensive review explores our current understanding of the etiology and pathogenesis of VAP and proposes a strategy for its treatment and prevention.
Incidence ; Intensive Care Units ; Mortality ; Pneumonia ; Pneumonia, Ventilator-Associated* ; Respiration, Artificial

Nosocomial pneumonia is a common complication of mechanical ventilation. However the actual incidence of pneumonia associated with ventilator is not known. A total of 57 consecutive patients submitted to mechanical ventilation(MV) for mqre than 48 hours in ICU were studied to investigate the incidence, etiology and consequence of ventilator associated pneumonia. Pneumonia was diagnosed when new and persistent radiographic infiltration was detected together with more than two of the following criteria; (l) fever more than 38degrees C, (2) leukocytosis more than 12000/mm, (3) purulent sputum with s gram stain showing bacteria. The results are as following: l) Twenty-one(37.9%) patients developed bacterial pneumonia during mechanical ventilation 2) Ventilator associated pneumonia was developed after 4.6 days of machanical ventilation 3) The etiology of pneumonia were Gram(-) bacilli 65.8%, Gram(+) bacilli 31.7% and, Pseudomonas 27.9%, Streptococcus 16.5% and or, Staphylococcus 13.9%.
Bacteria ; Fever ; Humans ; Incidence* ; Leukocytosis ; Pneumonia* ; Pneumonia, Bacterial ; Pneumonia, Ventilator-Associated ; Pseudomonas ; Respiration, Artificial* ; Sputum ; Staphylococcus ; Streptococcus ; Ventilation ; Ventilators, Mechanical

Nosocomial pneumonia is a common complication of mechanical ventilation. However the actual incidence of pneumonia associated with ventilator is not known. A total of 57 consecutive patients submitted to mechanical ventilation(MV) for mqre than 48 hours in ICU were studied to investigate the incidence, etiology and consequence of ventilator associated pneumonia. Pneumonia was diagnosed when new and persistent radiographic infiltration was detected together with more than two of the following criteria; (l) fever more than 38degrees C, (2) leukocytosis more than 12000/mm, (3) purulent sputum with s gram stain showing bacteria. The results are as following: l) Twenty-one(37.9%) patients developed bacterial pneumonia during mechanical ventilation 2) Ventilator associated pneumonia was developed after 4.6 days of machanical ventilation 3) The etiology of pneumonia were Gram(-) bacilli 65.8%, Gram(+) bacilli 31.7% and, Pseudomonas 27.9%, Streptococcus 16.5% and or, Staphylococcus 13.9%.
Bacteria ; Fever ; Humans ; Incidence* ; Leukocytosis ; Pneumonia* ; Pneumonia, Bacterial ; Pneumonia, Ventilator-Associated ; Pseudomonas ; Respiration, Artificial* ; Sputum ; Staphylococcus ; Streptococcus ; Ventilation ; Ventilators, Mechanical

BACKGROUND: Several antibiotics can be used to treat ventilator-associated pneumonia caused by carbapenem-resistant A. baumannii (CRAB-VAP) including high-dose sulbactam. However, the effectiveness of high-dose sulbactam therapy is not well known. We report our experience with high-dose sulbactam for treatment of CRAB-VAP. METHODS: Medical records of patients with CRAB-VAP who were given high-dose sulbactam between May 2013 and June 2015 were reviewed. RESULTS: Fifty-eight patients with CRAB-VAP were treated with high-dose sulbactam. The mean age was 72.0 ± 15.2 years, and the acute physiology and chronic health evaluation II (APACHE II) score was 15.1 ± 5.10 at the time of CRAB-VAP diagnosis. Early clinical improvement was observed in 65.5% of patients, and 30-day mortality was 29.3%. Early clinical failure (odds ratio [OR]: 8.720, confidence interval [CI]: 1.346-56.484; p = 0.023) and APACHE II score ≥ 14 at CRAB-VAP diagnosis (OR: 10.934, CI: 1.047-114.148; p = 0.046) were associated with 30-day mortality. CONCLUSIONS: High-dose sulbactam therapy may be effective for the treatment of CRAB-VAP. However, early clinical failure was observed in 35% of patients and was associated with poor outcome.
Acinetobacter baumannii* ; Acinetobacter* ; Anti-Bacterial Agents ; APACHE ; Diagnosis ; Humans ; Medical Records ; Mortality ; Pneumonia, Ventilator-Associated* ; Sulbactam*

BACKGROUND: Tracheobronchial suctioning using the closed suctioning system has physiological benefits for critically ill patients. Despite these benefits, there are concerns about increased colonization of tracheobronchial tree by pathogenic organisms. The cost is another hinder to the introduction of closed suction system. The aim of this study was to evaluate the incidence of colonization and ventilator associated pneumonia and the cost-effectiveness of closed suction compared with open suction. METHODS: During separated one month period, patients admitted MICU were cared by multiple-use, open suction, single-use, open suction and multiple-use, closed suction method, consecutively. Costs, colonization of tracheobronchial tree by MRSA and the incidence of ventilator-associated pneumonia (VAP) were analyzed. RESULTS: One-hundred and six patients were enrolled. Twenty patients were treated with multiple-use, open suction, while 42 and 44 patients were cared with single-use, open catheter and multiple-use, closed catheter, respectively. Colonization by MRSA and the incidence of VAP were not different among three ways of suctioning. The overall costs per patient per day for suctioning were 10.58 dollars for multiple-use, open suction, 28.27 dollars for single-use, open suction and 23.76 dollars for multiple-use, closed suction. CONCLUSION: Multiple-use, closed suctioning, when suction catheters were changed every 48 hrs, has the similar incidence of colonization of MRSA and occurrence of VAP and is a cost-efficient way of endotracheal suction.
Catheters ; Colon ; Critical Illness ; Humans ; Incidence ; Methicillin-Resistant Staphylococcus aureus ; Pneumonia, Ventilator-Associated ; Suction

BACKGROUNDThe presence of intracellular organisms (ICOs) in polymorphonuclear leukocytes obtained from bronchoalveolar lavage fluid (BALF) is a possible method for rapid diagnosis of ventilator-associated pneumonia (VAP). However, the validity of this diagnostic method remains controversial and the diagnostic thresholds reported by investigators were different. Our objective was to evaluate the accuracy of quantification of ICOs in BALF for the diagnosis of VAP, and to detect the best cutoff percentage of PMNs containing ICOs (PIC) in the microscopic examination of BALF for the diagnosis of VAP.

METHODSThis was a prospective multi-center study conducted in 4 ICUs in Wuhan, China, which involved 181 patients suspected of first episode of VAP. BALF was obtained from all enrolled patients. The BALF samples underwent quantitative culture, cytological and bacteriological analysis to detect the culture results, PIC values and the morphological features of microorganisms. Definite diagnosis of VAP was based on pre-set criteria. The receiver-operating characteristic curve was used to detect the best cutoff point for PIC to diagnose VAP, and the diagnostic accuracy was calculated. Moreover, quantitative culture and Gram's stain of BALF were adopted to diagnose VAP, and their diagnostic accuracy was evaluated as well.

RESULTSThere were 102 patients definitely diagnosed with VAP (VAP group), and 60 patients definitely diagnosed without VAP (no VAP group). We found that ICOs were present in 96.08% (98 out of 102) of VAP patients and 20.00% (12 out of 60) of no VAP patients. The PICs were significantly higher ((9.53 ± 6.65)% vs. (0.52 ± 1.33)%, P < 0.01) in VAP group. In our study, the best cutoff point for PIC to diagnose VAP was 1.5%,which had a sensitivity of 94.12%, a specificity of 88.33%, a positive predictive value (PPV) of 93.20% and a negative predictive value (NPV) of 89.83%.The area under the receiveroperating characteristic curve was 0.956 (95% confidence interval,0.925-0.986; P < 0.01). When the positive quantitative culture results of BALF were used to diagnose VAP, the sensitivity, specificity, PPV and NPV were 65.69%, 95.00%, 95.71% and 61.96%, respectively. Whereas they were 70.59%, 76.67%, 83.72% and 60.53%, respectively, when the positive Gram's stain results of BALF were used to diagnose VAP. The concordance between the results of Gram's stain and quantitative cultures was poor, only 32.10% (52 out of 162) was totally right, and 17.28% (28 out of 162) was partially right.

CONCLUSIONSPIC>1.5% has good diagnostic performance in the microscopic examination of BALF for the diagnosis of VAP. However, Gram's stain is not reliable for the early application of antibiotic therapy, due to the poor bacteriological predictive value.

Aged ; Bronchoalveolar Lavage Fluid ; microbiology ; Female ; Humans ; Male ; Middle Aged ; Pneumonia, Ventilator-Associated ; diagnosis ; Prospective Studies