La polmonite associata a ventilazione (VAP): l’importanza dell’assistenza infermieristica

Submitted: 3 January 2018
Accepted: 3 January 2018
Published: 1 April 2017
Abstract Views: 911
PDF (Italiano): 391
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Introduzione: La VAP (polmonite associata a ventilazione) è una forma di polmonite nosocomiale che colpisce pazienti intubati e sottoposti a ventilazione meccanica per un periodo superiore alle 48 ore. Essa rappresenta circa il 15% di tutte le infezioni nosocomiali e il 27% di tutte le infezioni acquisite nel reparto di terapia intensiva (TI). I tassi di mortalità vanno dal 24% al 50%, aumentando fino al 76% se l’infezione è causata da organismi antibiotico-resistenti. L’incidenza di questa pericolosa infezione varia dal 9% al 27%.
Obiettivo: L’obiettivo di questo elaborato è quello di fornire indicazioni riguardanti le migliori strategie di prevenzione della VAP, individuando quali sono gli interventi ritenuti efficaci a questo scopo e con quali modalità devono essere attuati.
Materiali e metodi: È stata eseguita una revisione di letteratura utilizzando le parole chiave “Pneumonia, Ventilator-Associatedâ€, “Nursingâ€, “Ventilators, Mechanicalâ€, “Pneumonia, Bacterialâ€, “Infection Controlâ€, “Oral Hygieneâ€, “Intensive Care Unitsâ€, “Patient Care Bundlesâ€.
Risultati: I fattori che possono portare allo sviluppo di VAP comprendono: la colonizzazione batterica dell’area orofaringea; l’aspirazione delle secrezioni subglottiche; la colonizzazione della placca dentale da parte di patogeni respiratori. Ai fattori elencati si possono aggiungere anche l’acquisizione esogena di microrganismi dalle mani del personale sanitario o attraverso apparecchiatura respiratoria contaminata. Dall’analisi della letteratura effettuata sono state identificate diverse strategie assistenziali, per la prevenzione della VAP, esse sono le seguenti: (1) Igiene del cavo orale; (2) Posizionamento del paziente; (3) Prevenzione dell’aspirazione e della sovradistensione gastrica durante la nutrizione enterale; (4) Gestione della cuffia del tubo endotracheale; (5) Aspirazione sottoglottica delle secrezioni; (6) Gestione del circuito respiratorio e dei presidi di ventilazione. Alla base di questi interventi assistenziali vi è l’assunzione delle corrette misure igieniche, che devono essere considerate le vere misure profilattiche dell’infezione.
Conclusioni: La prevenzione viene definita come “il modo più efficace per ridurre la VAPâ€; il personale infermieristico si può infatti avvalere di varie strategie assistenziali finalizzate a ridurre l’incidenza di questa pericolosa infezione. Le evidenze raccomandano quindi l’implementazione di programmi di formazione per aumentare la consapevolezza del personale sanitario rispetto alle migliori evidenze e pratiche per la prevenzione di VAP.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

hEck k. Decreasing ventilator-associated pneumonia in the intensive care unit: a sustainable comprehensive quality improvement program. Am J Infect Control 2012 Nov;40(9):877-9.
AnDrEWS t, StEEn c. A review of oral preventative strategies to reduce ventilator-associated pneumonia. Nurs Crit Care 2013 May;18(3):116-22.
Shi z, xiE h, WAng P, zhAng q, Wu y, chEn
E, Et Al. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev 2013 Aug 13;8:CD008367.
koEnig Sm, truWit JD. Ventilator-associated pneumonia: diagnosis, treatment, and prevention. Clin Microbiol Rev 2006 Oct;19(4):637-57.
HEALTHCARE INFECTION CONTROL PRAC- TICES ADVISORY COMMITTEE, CENTERS FOR DISEASE CONTROL AND PREVEN- TION (U.S.). Guidelines for preventing health-care-associated pneumonia, 2003 recommendations of the CDC and the Healthcare Infection Control Practices Advisory Committee. Respir Care 2004 Aug;49(8):926-39.
SuBrAmAniAn P, choy kl, goBAl Sv, mAnSor m, ng kh. Impact of education on ventilator-associated pneumonia in the intensive care unit. Singapore Med J 2013 May;54(5):281-4.
A STRATEGY FOR THE CONTROL OF ANTI- MICROBIAL RESISTANCE IN IRELAND. Gui- delines for the prevention of ventilator-as- sociated pneumonia in adults in Ireland. Health Protection Surveillance Centre 2011 Feb.
zhAng tt, tAng SS, Fu lJ. The effectiveness of different concentrations of chlorhexidine for prevention of ventilator-associated pneumonia: a meta-analysis. J Clin Nurs 2014 Jun;23(11-12):1461-75.
gmur c, irAni S, Attin t, mEnghini g, SchmiDlin Pr. Survey on oral hygiene measures for intubated patients in Swiss intensive care units. Schweiz Monatsschr Zahnmed 2013;123(5):394-409.
cASon cl, tynEr t, SAunDErS S, BroomE l, CENTERS FOR DISEASE CONTROL AND PREVENTION. Nurses’ implementation of guidelines for ventilator-associated pneu- monia from the Centers for Disease Con- trol and Prevention. Am J Crit Care 2007 Jan;16(1):28-36; discussion 37; quiz 38.
BAn ko. The effectiveness of an evidence- based nursing care program to reduce ventilator-associated pneumonia in a Korean ICU. Intensive Crit Care Nurs 2011 Aug;27(4):226-32.
JAnSSon m, AlA-kokko t, yliPAloSAAri P, SyrJAlA h, kyngAS h. Critical care nurses’ knowledge of, adherence to and barriers towards evidence-based guidelines for the prevention of ventilator-associated pneumonia--a survey study. Intensive Crit Care Nurs 2013 Aug;29(4):216-27.
mArShAll AP, WEiSBroDt l, roSE l, DuncAn E, Prior m, toDD l, Et Al. Implementing selective digestive tract decontamination in the intensive care unit: A qualitative analysis of nurse-identi ed considerations. Heart Lung 2014 Jan-Feb;43(1):13-8.
AgoDi A, AuxiliA F, BArchittA m, D’Errico mm, montAgnA mt, PASquArEllA c, Et Al. Control of intubator associated pneumonia in intensive care unit: results of the GISIO-SIt SPIN-UTI Project. Epidemiol Prev 2014 Nov-
Dec;38(6 Suppl 2):51-6.
SEDWick mB, lAncE-Smith m, rEEDEr SJ, nArDi
J. Using evidence-based practice to pre- vent ventilator-associated pneumonia. Crit Care Nurse 2012 Aug;32(4):41-51.
PAr m, BADovinAc A, PlAncAk D. Oral hygiene is an important factor for prevention of ventilator-associated pneumonia. Acta Clin Croat 2014 Mar;53(1):72-8.
S, nESci m, cElotto S, lucchini A. La polmonite da ventilatore. Minerva Anestesiol 2003 Apr;69(4):315-9
micik S, BESic n, JohnSon n, hAn m, hAmlyn S, BAll h. Reducing risk for ventilator associated pneumonia through nursing sensitive interventions. Intensive Crit Care Nurs 2013 Oct;29(5):261-5.
FlAnDErS SA, collArD hr, SAint S. Nosocomial pneumonia: state of the science. Am J Infect Control 2006 Mar;34(2):84-93.
AgoDi A, BArchittA m, ciPrESSo r, giAquintA l, romEo mA, DEnAro c. Pseudomonas aeruginosa carriage, colonization, and infection in ICU patients. Intensive Care Med 2007 Jul;33(7):1155-61.
AMERICAN THORACIC SOCIETY, INFEC- TIOUS DISEASES SOCIETY OF AMERICA. Guidelines for the management of adults with hospital-acquired, ventilator-associ- ated, and healthcare-associated pneu- monia. Am J Respir Crit Care Med 2005 Feb 15;171(4):388-416.
AuguStyn B. Ventilator-associated pneumo- nia: risk factors and prevention. Crit Care Nurse 2007 Aug;27(4):32-6, 38-9; quiz 40.
mAStErton rg, gAlloWAy A, FrEnch g, StrEEt m, ArmStrong J, BroWn E, Et Al. Guidelines for the management of hospital-acquired pneumonia in the UK: report of the wor- king party on hospital-acquired pneumo- nia of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 2008 Jul;62(1):5-34.
vilElA mc, FErrEirA gz, SAntoS PS, rEzEnDE nP. Oral care and nosocomial pneumonia: a systematic review. Einstein (Sao Paulo) 2015 Apr-Jun;13(2):290-6.
roBErtS n, moulE P. Chlorhexidine and tooth-brushing as prevention strategies in reducing ventilator-associated pneu- monia rates. Nurs Crit Care 2011 Nov- Dec;16(6):295-302.
DAlE c, AnguS JE, SinuFF t, mykhAlovSkiy E. Mouth care for orally intubated patients: a critical ethnographic review of the nursing literature. Intensive Crit Care Nurs 2013 Oct;29(5):266-74.
BErry Am, DAviDSon Pm, nicholSon l, PASquAlotto c, rollS k. Consensus based clinical guideline for oral hygiene in the critically ill. Intensive Crit Care Nurs 2011 Aug;27(4):180-5.
AmES nJ. Evidence to support tooth brushing in critically ill patients. Am J Crit Care 2011 May;20(3):242-50.
nEEDlEmAn ig, hirSch nP, lEEmAnS m, molES Dr, WilSon m, rEADy Dr, Et Al. Randomized controlled trial of toothbrushing to reduce ventilator-associated pneumonia pathogens and dental plaque in a critical care unit. J Clin Periodontol 2011 Mar;38(3):246-52.
lorEntE l, lEcuonA m, JimEnEz A, PAlmEro S, PAStor E, lAFuEntE n, Et Al. Ventilator- associated pneumonia with or without toothbrushing: a randomized controlled trial. Eur J Clin Microbiol Infect Dis 2012 Oct;31(10):2621-9.
Soh kl, ShAriFF ghAzAli S, Soh kg, ABDul rAmAn r, ShAriF ABDullAh SS, ong Sl. Oral care practice for the ventilated patients in intensive care units: a pilot survey. J Infect Dev Ctries 2012 Apr 13;6(4):333-9.
munro cl. Oral health: something to smile about! Am J Crit Care 2014 Jul;23(4):282- 8; quiz 289.
WintErS BD, BErEnholtz Sm. Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. Agency for Healthcare Research and Quality (US) 2013 Mar; Chapter 11.
ozcAkA o, BASoglu ok, BuDunEli n, tASBAkAn mS, BAcAkoglu F, kinAnE DF. Chlorhexidine decreases the risk of ventilator-associated pneumonia in intensive care unit patients: a randomized clinical trial. J Periodontal Res 2012 Oct;47(5):584-92.
lABEAu So, Blot Si. Toothbrushing does not need to reduce the risk of VAP to be indispensable. Eur J Clin Microbiol Infect Dis 2012 Nov;31(11):3257-8.
DAWSon D, EnDAcott r. Implementing quality initiatives using a bundled approach. Intensive Crit Care Nurs 2011 Jun;27(3):117-20.
cAPuzzi F, PAvAni m, SuArDi B. Rilevazione de- gli agenti patogeni all’interno del mate- riale disposable utilizzato con umidi catori attivi. Aniarti 2005;22 (1): 4-11.
hAmiShEkAr h, ShADvAr k, tAghizADEh m, golzAri SE, moJtAhEDzADEh m, SolEimAnPour h, Et Al. Ventilator-associated pneumonia in patients admitted to intensive care units, using open or closed endotracheal suctioning. Anesth Pain Med 2014 Sep 17;4(5):e21649.
loPES Fm, loPEz mF. Impact of the open and closed tracheal suctioning system on the incidence of mechanical ventilation associated pneumonia: literature review. Rev Bras Ter Intensiva 2009 Mar;21(1):80-8.
uzzi l, PAgAnElli P, Poli P. Broncoaspirazione a circuito aperto con guanto sterile Vs circuito chiuso. Aniarti 2007;24 (2): 21-9.
nEBuloni g. Infermieristica Medico- chirurgica. 3 edizione Milano: Casa Editrice Ambrosiana; 2006. 650-52 732-41.
rEllo J, AFonSo E, liSBoA t, ricArt m, BAlSErA B, rovirA A, Et Al. A care bundle approach for prevention of ventilator-associated pneumonia. Clin Microbiol Infect 2013 Apr;19(4):363-9

Supporting Agencies

How to Cite

Corso, M., & Collodel, V. (2017). La polmonite associata a ventilazione (VAP): l’importanza dell’assistenza infermieristica. Scenario® - Il Nursing Nella Sopravvivenza, 34(2), 22–28. https://doi.org/10.4081/scenario.2017.27