肺与呼吸系统医学

Systematic Review on the Importance of Preventive Measures for Pneumonia Associated with Mechanical Ventilation

Abstract

Coelho JF, Coelho AS and Filho IJZ

Introduction: Ventilator-associated pneumonia (VAP) occurs in 9.0% to 27.0% of patients on mechanical ventilation (MV) and has a global mortality rate of 13.0%. VAP is the most frequent infection acquired in the intensive care unit (ICU) among patients submitted to this ventilatory support, resulting in mortality rates’ ranging from 20.0% to 70.0%, with the use of antibiotics is presented in the literature as the most effective prophylactic measure.
Objective: The primary objective of this study was to review national and international scientific literature on preventive measures and pneumonia associated with mechanical ventilation. The secondary objective was to discuss the efficacy of preventive measures for ventilator-associated pneumonia.
Methods: After literary search criteria with the use of Mesh terms: pneumonia, antibiotics, prophylactic antibiotics, mechanical ventilation, patients at risk, major care, contamination and clinical trials and use of the bouleanos “and” between mesh terms and “or” among the historical findings. In the main databases such as Pubmed, Medline, Bireme, EBSCO, Scielo, etc., a total of 56 papers that were submitted to the eligibility analysis were cross-checked and after that 21 studies were selected, following the rules of systematic review-PRISMA.
Results: The results suggest that the use of intravenous and technological support that the surgical patient needs on the day of ICU admission is a risk factor for the development of VAP, as well as the prior use of antibiotics. In addition, the results confirm that VAP significantly increases the mechanical ventilation time and the time of ICU injection. Conclusion: EPI is an important cause of increased morbidity and mortality in severe ICU patients. Enteral nutrition was an important risk factor and previous use of antibiotic protection factor for the development of VAP. Studies to determine incidence and risk factors are useful in guiding the implementation of measures to improve diagnostic accuracy and to implement preventive measures.