PENCEGAHAN VENTILATOR-ASSOCIATED PNEUMONIA DENGAN PEMBERIAN PROFILAKSIS STRESS ULCERS

2017 ◽  
Vol 2 (1) ◽  
pp. 16
Author(s):  
Adinta Anandani
Keyword(s):  
Proton Pump ◽  
Stress Ulcer ◽  
Health Workers ◽  
Ventilator Associated Pneumonia ◽  
Stress Ulcers ◽  
H2 Blockers ◽  
H2 Blocker ◽  
Increased Risk ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Abstrak : Ventilator-associated pneumonia (VAP) adalah pneumonia yang terjadi lebih dari 48 jam setelah pemasangan intubasi endotrakeal akibat dari mikroorganisme yang masuk saluran pernapasan bagian bawah melalui aspirasi sekret orofaring yang berasal dari bakteri endemik di saluran pencernaan atau patogen eksogen yang diperoleh dari peralatan yang terkontaminasi atau petugas kesehatan. Terapi dengan menggunakan proton pump inhibitor sebagai profilaksis terhadap stress ulcer yang mungkin ditimbulkan akibat pemakaian ventilator mekanik mungkin terkait dengan peningkatan risiko terjadinya hospital acquired pneumonia (HAP). Berdasarkan data–data komparatif dari beberapa penelitian randomized IDSA (2005) merekomendasikan penggunaan sukralfat dibandingkan dengan H2-blocker dalam PSU untuk mengurangi kemungkinan timbulnya VAP. Abstract: Ventilator-associated pneumonia (VAP) is pneumonia that occurs more than 48 hours after endotracheal intubation due to microorganisms that enter the lower respiratory tract by aspiration of secretions oropharynx derived from endemic bacteria in the digestive tract or pathogen exogenous obtained from contaminated devices or health workers. Therapy using proton pump inhibitors as prophylaxis against stress ulcer (PSU) which may be incurred as a result of the use of a mechanical ventilator may be associated with an increased risk of hospital acquired pneumonia (HAP). Based on comparative data from several randomized studies IDSA (2005) recommends the use of sucralfate compared with H2-blockers in the PSU to reduce the likelihood of onset VAP.

scholarly journals Risk factors for 3-month mortality in bedridden patients with hospital-acquired pneumonia: A multicentre prospective study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0249198
Author(s):  
Jing Jiao ◽  
Zhen Li ◽  
Xinjuan Wu ◽  
Jing Cao ◽  
Ge Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Charlson Comorbidity Index Score ◽  
Ventilator Associated Pneumonia ◽  
Multilevel Regression ◽  
Care Plans ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired ◽  
Observation Period

Background Mortality among patients with hospital-acquired pneumonia (HAP) is quite high; however, information on risk factors for short-term mortality in this population remains limited. The aim of the current study was to identify the risk factors for mortality in bedridden patients with HAP during a 3-month observation period. Methods A secondary data analysis was conducted. In total, 1141 HAP cases from 25 hospitals were included in the analysis. Univariate and multilevel regression analyses were performed to identify the risk factors for mortality. Results During the 3-month observation period, there were 189 deaths among bedridden patients with HAP. The mortality rate in this study was 16.56%. Multilevel regression analysis showed that ventilator-associated pneumonia (OR = 2.034, 95%CI: 1.256, 3.296, p = 0.004), pressure injuries (OR = 2.202, 95%CI: 1.258, 3.852, p = 0.006), number of comorbidities (OR = 1.076, 95%CI: 1.016,1.140, p = 0.013) and adjusted Charlson Comorbidity Index score (OR = 1.210, 95%CI: 1.090, 1.343, p<0.001) were associated with an increased risk of mortality, while undergoing surgery with general anaesthesia (OR = 0.582, 95%CI: 0.368, 0.920, p = 0.021) was associated with a decreased risk of mortality. Conclusions The identification of risk factors associated with mortality is an important step towards individualizing care plans. Our findings may help healthcare workers select high-risk patients for specific interventions. Further study is needed to explore whether appropriate interventions against modifiable risk factors, such as reduced immobility complications or ventilator-associated pneumonia, could improve the prognoses.

scholarly journals Proton pump inhibitors versus histamine-2 receptor blockers for stress ulcer prophylaxis in patients with sepsis: a retrospective cohort study

2021 ◽  
Vol 49 (6) ◽  
pp. 030006052110251
Author(s):  
Minqiang Huang ◽  
Ming Han ◽  
Wei Han ◽  
Lei Kuang
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Proton Pump ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Stress Ulcer ◽  
Increased Risk ◽  
Ulcer Prophylaxis

Objective We aimed to compare the efficacy and risks of proton pump inhibitor (PPI) versus histamine-2 receptor blocker (H2B) use for stress ulcer prophylaxis (SUP) in critically ill patients with sepsis and risk factors for gastrointestinal bleeding (GIB). Methods In this retrospective cohort study, we used the Medical Information Mart for Intensive Care III Clinical Database to identify critically ill adult patients with sepsis who had at least one risk factor for GIB and received either an H2B or PPI for ≥48 hours. Propensity score matching (PSM) was conducted to balance baseline characteristics. The primary outcome was in-hospital mortality. Results After 1:1 PSM, 1056 patients were included in the H2B and PPI groups. The PPI group had higher in-hospital mortality (23.8% vs. 17.5%), GIB (8.9% vs. 1.6%), and pneumonia (49.6% vs. 41.6%) rates than the H2B group. After adjusting for risk factors of GIB and pneumonia, PPI use was associated with a 1.28-times increased risk of in-hospital mortality, 5.89-times increased risk of GIB, and 1.32-times increased risk of pneumonia. Conclusions Among critically ill adult patients with sepsis at risk for GIB, SUP with PPIs was associated with higher in-hospital mortality and higher risk of GIB and pneumonia than H2Bs.

scholarly journals In Vitro Activity of Doripenem, a Carbapenem for the Treatment of Challenging Infections Caused by Gram-Negative Bacteria, against Recent Clinical Isolates from the United States

2008 ◽  
Vol 52 (12) ◽  
pp. 4388-4399 ◽  
Author(s):  
Chris M. Pillar ◽  
Mohana K. Torres ◽  
Nina P. Brown ◽  
Dineshchandra Shah ◽  
Daniel F. Sahm
Keyword(s):  
The United States ◽  
Clinical Isolates ◽  
Gram Negative Bacteria ◽  
Ventilator Associated Pneumonia ◽  
Coagulase Negative Staphylococci ◽  
Hospital Acquired Pneumonia ◽  
Abdominal Infections ◽  
Hospital Acquired ◽  
Gram Positive Cocci

ABSTRACT Doripenem, a 1β-methylcarbapenem, is a broad-spectrum antibiotic approved for the treatment of complicated urinary tract and complicated intra-abdominal infections. An indication for hospital-acquired pneumonia including ventilator-associated pneumonia is pending. The current study examined the activity of doripenem against recent clinical isolates for the purposes of its ongoing clinical development and future longitudinal analysis. Doripenem and comparators were tested against 12,581 U.S. clinical isolates collected between 2005 and 2006 including isolates of Staphylococcus aureus, coagulase-negative staphylococci, Streptococcus pneumoniae, Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter spp. MICs (μg/ml) were established by broth microdilution. By MIC90, doripenem was comparable to imipenem and meropenem in activity against S. aureus (methicillin susceptible, 0.06; resistant, 8) and S. pneumoniae (penicillin susceptible, ≤0.015; resistant, 1). Against ceftazidime-susceptible Enterobacteriaceae, the MIC90 of doripenem (0.12) was comparable to that of meropenem (0.12) and superior to that of imipenem (2), though susceptibility of isolates exceeded 99% for all evaluated carbapenems. The activity of doripenem was not notably altered against ceftazidime-nonsusceptible or extended-spectrum β-lactamase screen-positive Enterobacteriaceae. Doripenem was the most potent carbapenem tested against P. aeruginosa (MIC90/% susceptibility [%S]: ceftazidime susceptible = 2/92%S, nonsusceptible = 16/61%S; imipenem susceptible = 1/98.5%S, nonsusceptible = 8/56%S). Against imipenem-susceptible Acinetobacter spp., doripenem (MIC90 = 2, 89.1%S) was twice as active by MIC90 as were imipenem and meropenem. Overall, doripenem potency was comparable to those of meropenem and imipenem against gram-positive cocci and doripenem was equal or superior in activity to meropenem and imipenem against Enterobacteriaceae, including β-lactam-nonsusceptible isolates. Doripenem was the most active carbapenem tested against P. aeruginosa regardless of β-lactam resistance.

scholarly journals Incidence of ventilator associated pneumonia in tracheostomised and non tracheostomised patients

2018 ◽  
Vol 6 (8) ◽  
pp. 2754
Author(s):  
David D. M. Rosario ◽  
Anitha Sequeira
Keyword(s):  
Mechanical Ventilation ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Early Tracheostomy ◽  
Hospital Acquired Infection ◽  
Total Incidence ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Background: Pneumonia is the most common hospital acquired infection in the intensive care unit. One of the causes for hospital acquired pneumonia is ventilator associated pneumonia. Tracheostomy is known to prevent occurrence of ventilator associated pneumonia as it decreases the respiratory dead space, assists in better clearance of secretions and prevents chances of aspiration. Generally, tracheostomy is done after 2 weeks of endotracheal intubation to prevent tracheal complications. The aim of this study is to identify the incidence of ventilator associated pneumonia in tracheostomised and non tracheostomised patients and to see if early tracheostomy can prevent development of ventilator associated pneumonia.Methods: The study was conducted at a tertiary care hospital during a period of four years. 100 patients who were on mechanical ventilation for more than 7 days where taken up for the study. APACHE 4 scoring system was used. The incidence of Ventilator associated pneumonia in tracheostomised and non tracheostomised patients was studied.Results: In our study the total incidence of VAP was 44 %. In our study out of the 42 patients who had undergone tracheostomy 13 (30.95%) patients had ventilator associated pneumonia. Among the non-tracheostomised patients 31 (53.44%) out of 58 patients developed ventilator associated pneumonia. In our study the incidence of ventilator associated pneumonia was much lesser (12%) in patients who underwent tracheostomy in the period 7 to 10 days after mechanical ventilation, whereas in those who underwent tracheostomy after 11 days incidence of ventilator associated pneumonia was much higher.Conclusions: Our study showed that the incidence of ventilator associated pneumonia was much higher among non tracheostomised patients compared to patients who underwent tracheostomy. Hence patients undergoing earlier tracheostomy had a clear advantage than those undergoing tracheostomy late or non tracheostomised patients in preventing ventilator associated pneumonia.

scholarly journals International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia

2017 ◽  
Vol 50 (3) ◽  
pp. 1700582 ◽  
Author(s):  
Antoni Torres ◽  
Michael S. Niederman ◽  
Jean Chastre ◽  
Santiago Ewig ◽  
Patricia Fernandez-Vandellos ◽  
...  
Keyword(s):  
Ventilator Associated Pneumonia ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

scholarly journals Executive Summary: Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society

2016 ◽  
Vol 63 (5) ◽  
pp. 575-582 ◽  
Author(s):  
Andre C. Kalil ◽  
Mark L. Metersky ◽  
Michael Klompas ◽  
John Muscedere ◽  
Daniel A. Sweeney ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Healthcare Professionals ◽  
Healthcare Providers ◽  
Ventilator Associated Pneumonia ◽  
Executive Summary ◽  
Literature Reviews ◽  
Physician Judgment ◽  
Patients At Risk ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Abstract It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances. These guidelines are intended for use by healthcare professionals who care for patients at risk for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), including specialists in infectious diseases, pulmonary diseases, critical care, and surgeons, anesthesiologists, hospitalists, and any clinicians and healthcare providers caring for hospitalized patients with nosocomial pneumonia. The panel's recommendations for the diagnosis and treatment of HAP and VAP are based upon evidence derived from topic-specific systematic literature reviews.

scholarly journals Performance and impact of a multiplex PCR in ICU patients with ventilator-associated pneumonia or ventilated hospital-acquired pneumonia

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Nathan Peiffer-Smadja ◽  
Lila Bouadma ◽  
Vincent Mathy ◽  
Kahina Allouche ◽  
Juliette Patrier ◽  
...  
Keyword(s):  
Multiplex Pcr ◽  
Ventilator Associated Pneumonia ◽  
Icu Patients ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired
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