Effectiveness of a Ventilator Care Bundle to Prevent Ventilator-Associated Pneumonia at the PICU: A Systematic Review and Meta-Analysis
| Autor: | P. Raymakers-Janssen, Leo Bakker, Sandra Dijkstra, Alicija Vileito, Erwin Ista, Marjorie de Neef |
|---|---|
| Přispěvatelé: | Academic Medical Center, Nursing, Paediatric Intensive Care, Pediatric Surgery |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
COUNTRIES medicine.medical_specialty Evidence-based practice IMPACT education MEDLINE evidence-based practice CHILDREN 030204 cardiovascular system & hematology Intensive Care Units Pediatric Critical Care and Intensive Care Medicine 03 medical and health sciences ventilator-associated pneumonia 0302 clinical medicine Ventilator care SURVEILLANCE medicine Humans QUALITY Care bundle Child Intensive care medicine implementation NOSOCOMIAL INFECTIONS business.industry Critically ill UNITS Ventilator-associated pneumonia Pneumonia Ventilator-Associated 030208 emergency & critical care medicine FOR-DISEASE-CONTROL Length of Stay medicine.disease Quality Improvement Respiration Artificial Pneumonia TRACHEOBRONCHITIS pediatric intensive care Controlled Before-After Studies Meta-analysis Pediatrics Perinatology and Child Health Female care bundle business Patient Care Bundles INTERVENTIONS |
| Zdroj: | de Neef, M, Bakker, L, Dijkstra, S, Raymakers-Janssen, P, Vileito, A & Ista, E 2019, ' Effectiveness of a Ventilator Care Bundle to Prevent Ventilator-Associated Pneumonia at the PICU: A Systematic Review and Meta-Analysis ', Pediatric critical care medicine, vol. 20, no. 5, pp. 474-480 . https://doi.org/10.1097/PCC.0000000000001862 Pediatric critical care medicine, 20(5), 474-480. Lippincott Williams and Wilkins Pediatric Critical Care Medicine, 20(5), 474-480. Lippincott Williams & Wilkins |
| ISSN: | 1529-7535 |
| DOI: | 10.1097/pcc.0000000000001862 |
| Popis: | Objectives: Ventilator-associated pneumonia is one of the most frequent hospital-acquired infections in mechanically ventilated children. We reviewed the literature on the effectiveness of ventilator care bundles in critically ill children. Data Sources: Embase, Medline OvidSP, Web-of-Science, Cochrane Library, and PubMed were searched from January 1990 until April 2017. Study Selection: Studies were included if they met the following criteria: 1) implementation of a ventilator care bundle in PICU setting; 2) quality improvement or multicomponent approach with the (primary) objective to lower the ventilator-associated pneumonia rate (expressed as ventilator-associated pneumonia episodes/1,000 ventilator days); and 3) made a comparison, for example, with or without ventilator care bundle, using an experimental randomized or nonrandomized study design, or an interrupted-times series. Exclusion criteria were (systematic) reviews, guidelines, descriptive studies, editorials, or poster publications. Data Extraction: The following data were collected from each study: design, setting, patient characteristics (if available), number of ventilator-associated pneumonia per 1,000 ventilator days, ventilator-associated pneumonia definitions used, elements of the ventilator care bundle, and implementation strategy. Ambiguities about data extraction were resolved after discussion and consulting a third reviewer (M.N., E.I.) when necessary. We quantitatively pooled the results of individual studies, where suitable. The primary outcome, reduction in ventilator-associated pneumonia per 1,000 ventilator days, was expressed as an incidence risk ratio with a 95% CI. All data for meta-analysis were pooled by using a DerSimonian and Laird random effect model. Data Synthesis: Eleven articles were included. The median ventilator-associated pneumonia incidence decreased from 9.8 (interquartile range, 5.8-18.5) per 1,000 ventilator days to 4.6 (interquartile range, 1.2-8.6) per 1,000 ventilator days after implementation of a ventilator care bundle. The meta-analysis showed that the implementation of a ventilator care bundle resulted in significantly reduced ventilator-associated pneumonia incidences (incidence risk ratio = 0.45; 95% CI, 0.33-0.60; p < 0.0001; I 2 = 55%). Conclusions: Implementation of a ventilator-associated pneumonia bundle has the potential to reduce the prevalence of ventilator-associated pneumonia in mechanically ventilated children. |
| Databáze: | OpenAIRE |
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