Prevention of ventilator-associated pneumonia through care bundles:A systematic review and meta-analysis  

作　　者：Raquel Martinez-Reviejo Sofia Tejada Miia Jansson Alfonsina Ruiz-Spinelli Sergio Ramirez-Estrada Duygu Ege Tarsila Vieceli Bert Maertens Stijn Blot Jordi Rello 

机构地区：[1]Centro de Investigación Biomédica en Red de Enfermedades Respiratorias(CIBERES),Instituto de Salud Carlos III,Madrid 28029,Spain [2]Clinical Research Epidemiology in Pneumonia&Sepsis(CRIPS),Vall d'Hebron Institute of Research(VHIR),Barcelona 08035,Spain [3]Research Unit of Health Sciences and Technology,University of Oulu,Oulu,90570,Finland [4]RMIT University,Melbourne,3010,Australia [5]Critical Care Department,Hospital de Clínicas Dr.Manuel Quintela,Montevideo,11600,Uruguay [6]Critical Care Department,Clínica Corachan,Barcelona,08017,Spain [7]Emergency Medicine Department,Adnan Menderes University,Aydin,09010,Turkey [8]Infectious Diseases Department,Hospital de Clínicas de Porto Alegre,Porto Alegre,90035-903,Brazil [9]Department of Internal Medicine and Pediatrics,Ghent University,Ghent,9000,Belgium [10]FOREVA Clinical Research,CHU Nimes,Universitéde Nîmes-Montpellier,Nîmes,30012,France [11]Medicine Department,Universitat Internacional de Catalunya(UIC),Barcelona,08017,Spain

出　　处：《Journal of Intensive Medicine》2023年第4期352-364,共13页重症医学（英文）

基　　金：supported by CIBERES,Instituto de Salud Carlos III,Madrid,Spain (grant number:Fondos FEDER:CB06-06-036).

摘　　要：Background Ventilator-associated pneumonia(VAP)represents a common hospital-acquired infection among mechanically ventilated patients.We summarized evidence concerning ventilator care bundles to prevent VAP.Methods A systematic review and meta-analysis were performed.Randomized controlled trials and controlled observational studies of adults undergoing mechanical ventilation(MV)for at least 48 h were considered for inclusion.Outcomes of interest were the number of VAP episodes,duration of MV,hospital and intensive care unit(ICU)length of stay,and mortality.A systematic search was conducted in the MEDLINE,the Cochrane Library,and the Web of Science between 1985 and 2022.Results are reported as odds ratio(OR)or mean difference(MD)with 95%confidence intervals(CI).The PROSPERO registration number is CRD42022341780.Results Thirty-six studies including 116,873 MV participants met the inclusion criteria.A total of 84,031 participants underwent care bundles for VAP prevention.The most reported component of the ventilator bundle was head-of-bed elevation(n=83,146),followed by oral care(n=80,787).A reduction in the number of VAP episodes was observed among those receiving ventilator care bundles,compared with the non-care bundle group(OR=0.42,95%CI:0.33,0.54).Additionally,the implementation of care bundles decreased the duration of MV(MD=−0.59,95%CI:−1.03,−0.15)and hospital length of stay(MD=−1.24,95%CI:−2.30,−0.18)in studies where educational activities were part of the bundle.Data regarding mortality were inconclusive.Conclusions The implementation of ventilator care bundles reduced the number of VAP episodes and the duration of MV in adult ICUs.Their application in combination with educational activities seemed to improve clinical outcomes.

关 键 词：Hospital-acquired pneumonia Ventilator bundle PREVENTION Quality improvement intervention 

分 类 号：R563.1[医药卫生—呼吸系统]