Atualizações sobre as medidas de prevenção de pneumonia associada à ventilação mecânica (PAVM) no adulto
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Jun 7, 2023
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Resumo
Objetivo: Descrever as principais atualizações do bundle de Pneumonia associada à ventilação mecânica (PAVM), assim como relacioná-las com evidências encontradas na literatura. Revisão bibliográfica: Os componentes do bundle de PAVM incluem os seguintes: manter decúbito elevado (30-45°); adequar diariamente o nível de sedação e o teste de respiração espontânea; aspirar a secreção subglótica rotineiramente; fazer a higiene oral com antissépticos; fazer uso criterioso de bloqueadores neuromusculares; dar preferência por utilizar ventilação mecânica não-invasiva; cuidados com o circuito do ventilador; indicação e cuidados com os umidificadores; indicação e cuidados com o sistema de aspiração; evitar extubação não programada (acidental) e reintubação; monitoramento da pressão de cuff; dar preferência a intubação orotraqueal; cuidados com inaladores e nebulizadores; sonda enteral na posição gástrica ou pós-pilórica; processamento de produto de assistência respiratória. Embora haja alguma discordância em relação aos componentes específicos do bundle entre alguns pesquisadores, a redução da PAVM tem sido alcançada, desde que haja um alto nível de conformidade (acima de 95%) dos componentes principais do bundle. Com uma adesão tão alta, a PAVM pode ser prevenida de forma eficaz. Considerações finais: Considera-se que o pacote de medidas de prevenção pode salvar vidas e reduzir custos de tratamentos, assim recomenda-se a realização de mais estudos observacionais a respeito da efetividade dos bundles nas UTIs.
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Como Citar
SilvaW. M. da, SilvaS. J. da, SilvaS. B. da, SouzaJ. N. V. A., Silva JúniorJ. A. da, SilvaD. P. de F., SantosA. H. S. dos, LimaA. F. S. de, LimaA. L. de, & SantosE. J. dos. (2023). Atualizações sobre as medidas de prevenção de pneumonia associada à ventilação mecânica (PAVM) no adulto. Revista Eletrônica Acervo Saúde, 23(6), e12368. https://doi.org/10.25248/reas.e12368.2023
Seção
Revisão Bibliográfica
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Referências
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11. DEVLIN JW, et al. Executive summary: Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult ICU patients. Critical Care Medicine, 2018; 46: 1532 – 1548.
12. DUTRA LA, et al. Pneumonia associada à ventilação mecânica: percepção dos profissionais de enfermagem. Revista de Enfermagem UFPE, 2019; 13(4): 884- 892.
13. GARBUIO DC, et al. Caracterização das infecções relacionadas a assistência à saúde em unidade de terapia intensiva adulto. Revista de Epidemiologia e Controle de Infecção, 2022; 12(1): 1-12.
14. GETAHUN AB, et al. Knowledge of intensive care nurses’ towards prevention of ventilator-associated pneumonia in North West Ethiopia referral hospitals, 2021: A multicenter, cross-sectional study. Annals of Medicine and Surgery, 2022; 78: 103895.
15. GIRARD TD, et al. An official American Thoracic Society/American College of Chest Physicians clinical practice guideline: liberation from mechanical ventilation in critically adults. Rehabilitation protocols, ventilator release protocols, and cuff leak tests. American Journal of Respiratory and Critical Care Medicine, 2017; 195: 120–133.
16. GIRARD TD, et al. An official clinical practice guideline of the American Thoracic Society/American College of Chest Physicians: release from mechanical ventilation in critically ill adults. Rehabilitation protocols, ventilator release protocols, and cuff leak testing. American Journal of Respiratory and Critical Care Medicine, 2017; 195: 120 – 133.
17. HAN, J, LIU, Y. Effect of ventilator circuit changes on ventilator-associated pneumonia: a systematic review and meta-analysis. Respira Care, 2010; 55: 467 – 474.
18. HELLYER TP, et al. The Intensive Care Society recommended bundle of interventions for the prevention of ventilator-associated pneumonia. Journal of the Intensive Care Society, 2016.
19. IHI. Institute for Healthcare Improvement. Prevent How-to Guide: Prevent Ventilator-Associated Pneumonia. Cambridge: Institute for Healthcare Improvement, 2012.
20. JI T, et al. Preventive effect of probiotics on ventilator-associated pneumonia: a meta-analysis of 2,428 patients. Ann Pharmacother 2021; 55:949–962.
21. KLOMPAS M, et al. Reevaluation of routine oral hygiene with chlorhexidine gluconate for mechanically ventilated patients: systematic review and meta-analysis. JAMA Internal Medicine, 2014; 174: 751 – 761.
22. KLOMPAS M, et al. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022. Infection Control & Hospital Epidemiology, 2022; 43(6): 687-713.
23. KLOMPAS M. Silver-coated endotracheal tubes and patient outcomes in ventilator-associated pneumonia. Journal of the American Medical Association, 2008; 300: 2605.
24. LEMOS AS, et al. Análise das infecções do trato respiratório em unidade de terapia intensiva de um hospital do sul do Brasil. Research, Society and Development, 2021; 10(17): 1-11.
25. MEHERALI SM, et al. Nurses’ knowledge of evıdence-based guıdelınes for preventıon of ventılator-assocıated pneumonıa in crıtıcal care areas: A pre and post test design. Journal of Ayub Medical College Abbottabad, 2011; 23(1): 146-149.
26. MENDONÇA DL, et al. Prevalência e perfil de sensibilidade dos microrganismos isolados em aspirado traqueal de pacientes com pneumonia associada à ventilação mecânica em unidade de terapia intensiva. Revista Ciências em Saúde, 2019; 9(4): 3-7, 2019.
27. OSADNIK CR, et al. Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database Systemic Review, 2017; 7: CD004104.
28. SEVDI MS, et al. Continuous endotracheal tube cuff pressure control decreases incidence of ventilator-associated pneumonia in patients with traumatic brain injury. Journal of Investigative Surgery, 2022; 35:525–530.
29. SILVA MFO, et al. A adesão aos bundles reduz a prevalência de pneumonia associada a ventilação mecânica? Brazilian Journal of Development, 2020; 6(1): 5334-5342.
30. SOZKES S, SOZKES, S. Use of toothbrushing in conjunction with chlorhexidine to prevent ventilator-associated pneumonia: a random-effect meta-analysis of randomized controlled trials. International Journal of Dental Hygiene, 2021.
31. TEIXEIRA MR, et al. Intervenção educativa em uma equipe de enfermagem sobre higiene bucal de pacientes críticos na unidade de terapia intensiva. Revista Naval de Odontologia, 2022; 49 (2): 5-17.
32. VASCHETTO R, et al. Effects of early extubation followed by non-invasive ventilation versus standard extubation on the duration of invasive mechanical ventilation in non-hypercapnic hypoxemic patients: a systematic review and meta-analysis of individual patient data from randomized controlled trials. Critical Care (London), 2021; 25: 189.
33. WANG L, et al. Semirecumbent versus supine position for the prevention of ventilator-associated pneumonia in adults requiring mechanical ventilation. Cochrane Database Systemic Review, 2016: CD009946.
34. WITTEKAMP BH, et al. Decontamination strategies and bloodstream infections with antibiotic-resistant microorganisms in ventilated patients: a randomized controlled trial. JAMA, 2018; 320: 2087 – 2098.
35. YASUDA H, et al. Post-extubation oxygenation strategies in acute respiratory failure: a systematic review and network meta-analysis. Critical Care (London), 2021; 25: 135.
2. BANKANIE V, et al. Assessment of knowledge and compliance to evidence-based guidelines for VAP prevention among ICU nurses in Tanzania. BMC Nurse. 2021; 20: 209.
3. BARBATESKOVIC M, et al. Stress ulcer prophylaxis with proton pump inhibitors or histamin-2 receptor antagonists in adult intensive care patients: a systematic review with meta-analysis and trial sequential analysis. Intensive Care Medicine, 2019; 45:143–158.
4. BRASIL. Agência Nacional de Vigilância Sanitária (BR). Medidas de prevenção de infecção relacionada à assistência à saúde. Brasília: Anvisa; 2017.
5. BRASIL. Agência Nacional de Vigilância Sanitária. Critérios Diagnósticos de Infecção Relacionada à Assistência à Saúde. Brasília: Anvisa; 2017.
6. CDC. Centers for Disease Control and Prevention. Ventilator-Associated Event, 2015 Version.
7. DALE CM, et al. Effect of oral chlorhexidine de-adoption and implementation of an oral care bundle on mortality for mechanically ventilated patients in the intensive care unit (CHORAL): a mult-center stepped-wedge cluster-randomized controlled trial. Intensive Care Medicine, 2021; 47:1295–1302.
8. DAT VQ, et al. Effectiveness of continuous endotracheal cuff pressure control for the prevention of ventilator associated respiratory infections: an open-label randomised, controlled trial. Clinical Infectious Diseases, 2021.
9. DAVID LE, et al. Perfil de microrganismos multirresistentes causadores de pneumonia associada à ventilação mecânica. The Brazilian Journal of Infectious Diseases, 2022; 26(1): 102260.
10. DESCHEPPER M, et al. Effects of oral hygiene with chlorhexidine gluconate on hospital mortality: a hospital-wide observational cohort study. Intensive Care Medicine, 2018; 44: 1017 – 1026.
11. DEVLIN JW, et al. Executive summary: Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult ICU patients. Critical Care Medicine, 2018; 46: 1532 – 1548.
12. DUTRA LA, et al. Pneumonia associada à ventilação mecânica: percepção dos profissionais de enfermagem. Revista de Enfermagem UFPE, 2019; 13(4): 884- 892.
13. GARBUIO DC, et al. Caracterização das infecções relacionadas a assistência à saúde em unidade de terapia intensiva adulto. Revista de Epidemiologia e Controle de Infecção, 2022; 12(1): 1-12.
14. GETAHUN AB, et al. Knowledge of intensive care nurses’ towards prevention of ventilator-associated pneumonia in North West Ethiopia referral hospitals, 2021: A multicenter, cross-sectional study. Annals of Medicine and Surgery, 2022; 78: 103895.
15. GIRARD TD, et al. An official American Thoracic Society/American College of Chest Physicians clinical practice guideline: liberation from mechanical ventilation in critically adults. Rehabilitation protocols, ventilator release protocols, and cuff leak tests. American Journal of Respiratory and Critical Care Medicine, 2017; 195: 120–133.
16. GIRARD TD, et al. An official clinical practice guideline of the American Thoracic Society/American College of Chest Physicians: release from mechanical ventilation in critically ill adults. Rehabilitation protocols, ventilator release protocols, and cuff leak testing. American Journal of Respiratory and Critical Care Medicine, 2017; 195: 120 – 133.
17. HAN, J, LIU, Y. Effect of ventilator circuit changes on ventilator-associated pneumonia: a systematic review and meta-analysis. Respira Care, 2010; 55: 467 – 474.
18. HELLYER TP, et al. The Intensive Care Society recommended bundle of interventions for the prevention of ventilator-associated pneumonia. Journal of the Intensive Care Society, 2016.
19. IHI. Institute for Healthcare Improvement. Prevent How-to Guide: Prevent Ventilator-Associated Pneumonia. Cambridge: Institute for Healthcare Improvement, 2012.
20. JI T, et al. Preventive effect of probiotics on ventilator-associated pneumonia: a meta-analysis of 2,428 patients. Ann Pharmacother 2021; 55:949–962.
21. KLOMPAS M, et al. Reevaluation of routine oral hygiene with chlorhexidine gluconate for mechanically ventilated patients: systematic review and meta-analysis. JAMA Internal Medicine, 2014; 174: 751 – 761.
22. KLOMPAS M, et al. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022. Infection Control & Hospital Epidemiology, 2022; 43(6): 687-713.
23. KLOMPAS M. Silver-coated endotracheal tubes and patient outcomes in ventilator-associated pneumonia. Journal of the American Medical Association, 2008; 300: 2605.
24. LEMOS AS, et al. Análise das infecções do trato respiratório em unidade de terapia intensiva de um hospital do sul do Brasil. Research, Society and Development, 2021; 10(17): 1-11.
25. MEHERALI SM, et al. Nurses’ knowledge of evıdence-based guıdelınes for preventıon of ventılator-assocıated pneumonıa in crıtıcal care areas: A pre and post test design. Journal of Ayub Medical College Abbottabad, 2011; 23(1): 146-149.
26. MENDONÇA DL, et al. Prevalência e perfil de sensibilidade dos microrganismos isolados em aspirado traqueal de pacientes com pneumonia associada à ventilação mecânica em unidade de terapia intensiva. Revista Ciências em Saúde, 2019; 9(4): 3-7, 2019.
27. OSADNIK CR, et al. Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database Systemic Review, 2017; 7: CD004104.
28. SEVDI MS, et al. Continuous endotracheal tube cuff pressure control decreases incidence of ventilator-associated pneumonia in patients with traumatic brain injury. Journal of Investigative Surgery, 2022; 35:525–530.
29. SILVA MFO, et al. A adesão aos bundles reduz a prevalência de pneumonia associada a ventilação mecânica? Brazilian Journal of Development, 2020; 6(1): 5334-5342.
30. SOZKES S, SOZKES, S. Use of toothbrushing in conjunction with chlorhexidine to prevent ventilator-associated pneumonia: a random-effect meta-analysis of randomized controlled trials. International Journal of Dental Hygiene, 2021.
31. TEIXEIRA MR, et al. Intervenção educativa em uma equipe de enfermagem sobre higiene bucal de pacientes críticos na unidade de terapia intensiva. Revista Naval de Odontologia, 2022; 49 (2): 5-17.
32. VASCHETTO R, et al. Effects of early extubation followed by non-invasive ventilation versus standard extubation on the duration of invasive mechanical ventilation in non-hypercapnic hypoxemic patients: a systematic review and meta-analysis of individual patient data from randomized controlled trials. Critical Care (London), 2021; 25: 189.
33. WANG L, et al. Semirecumbent versus supine position for the prevention of ventilator-associated pneumonia in adults requiring mechanical ventilation. Cochrane Database Systemic Review, 2016: CD009946.
34. WITTEKAMP BH, et al. Decontamination strategies and bloodstream infections with antibiotic-resistant microorganisms in ventilated patients: a randomized controlled trial. JAMA, 2018; 320: 2087 – 2098.
35. YASUDA H, et al. Post-extubation oxygenation strategies in acute respiratory failure: a systematic review and network meta-analysis. Critical Care (London), 2021; 25: 135.