title: Assessment of the effectiveness of a ventilator associated pneumonia prevention bundle that contains endotracheal tube with subglottic drainage and cuff pressure monitorization.
abstract: The effectiveness of prevention bundles on the occurrence and mortality of ventilator associated pneumonia (VAP) was evaluated in many studies. However, the effectiveness of endotracheal tube with subglottic secretion drainage (ETT-SD) and cuff pressure monitorization in VAP bundles have not been adequately assessed. In this study, we aimed to evaluate the effectiveness of VAP bundle containing ETT-SD and cuff pressure monitorization. This was a prospective, controlled study that was carried out between March 2011 and April 2012 including intubated patients. The study was conducted at the Anesthesiology Intensive Care Unit 1 and 2 (10 beds each) in a 898-bed university hospital. Occurrence of VAP and compliance with the parameters of the VAP prevention bundles were assessed daily. Patients intubated with the standard endotracheal tube were recruited as controls, mainly in the first six months of the study as ETT-SD and cuff pressure monometer had not yet been implemented. In the second term, patients intubated with ETT-SD were included as cases. Occurrence of VAP, mortality, and compliance with VAP prevention bundles were monitored. A total of 133 patients, 37 cases and 96 controls were recruited. VAP incidence declined from 40.82 to 22.16 per 1000 ventilator days among controls and cases, respectively (p<005). On average, VAP occurred 17.33±21.09 days in the case group and 10.43±7.83 days in the control group (p=0.04). However, mortality of cases and controls at the 14th and 30th days was not different. VAP prevention bundles including the utilization of ETT-SD, monitoring cuff pressure, and oral care with chlorhexidine were efficient in reducing the rate of VAP.
authors.affiliation: Inonu University School of Medicine, Department of Infectious Diseases & Clinical Microbiology, Malatya, Turkey.
authors.forename: Ozlem
authors.initials: O
authors.lastname: Akdogan
authors.affiliation: Inonu University School of Medicine, Department of Infectious Diseases & Clinical Microbiology, Malatya, Turkey. Electronic address: dryasemin@hotmail.com.
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Ersoy
authors.affiliation: Inonu University School of Medicine, Department of Anesthesiology and Reanimation, Malatya, Turkey.
authors.forename: Ciğdem
authors.initials: C
authors.lastname: Kuzucu
authors.affiliation: Inonu University School of Medicine, Department of Medical Microbiology, Malatya, Turkey.
authors.forename: Ender
authors.initials: E
authors.lastname: Gedik
authors.affiliation: Inonu University School of Medicine, Department of Medical Microbiology, Malatya, Turkey.
authors.forename: Turkan
authors.initials: T
authors.lastname: Togal
authors.affiliation: Inonu University School of Medicine, Department of Infectious Diseases & Clinical Microbiology, Malatya, Turkey.
authors.forename: Funda
authors.initials: F
authors.lastname: Yetkin
mesh_terms: D016022:Case-Control Studies; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D011446:Prospective Studies; D015203:Reproducibility of Results
keywords: Cuff pressure monitorization; Subglottic secretion drainage; VAP prevention bundles; Ventilator associated pneumonia