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Introdução: a Pneumonia Associada à Ventilação Mecânica é a mais importante e comum infecção que acomete os pacientes em ventilação mecânica. Além disso, é considerada um grave problema de saúde hospitalar, com preocupantestaxas de morbimortalidade.Objetivo: investigar na literatura quais as principais ações de enfermagem para a prevenção da Pneumonia Associada à Ventilação Mecânica. Metodologia:trata-se de um estudo do tipo revisão integrativa da literatura. Após utilizar a estratégia PICO, definiu-se a seguinte pergunta norteadora: "Quais as principais intervenções de enfermagem para a prevenção da Pneumonia Associada à Ventilação Mecânica?". Com a leitura e aplicação dos critérios de seleção, foram utilizados nove artigos. Resultados:as principais intervenções de enfermagem descritas foram elevação da cabeceira entre 30-45 graus, manter pressão do cuff entre 20 e 30 cmH2O, higienização oral com clorexidina 0,12%, higienização das mãos, aspiração de secreções e interrupção diária da sedação. Com relação à adesão dos profissionais, a maioria das intervenções atingiram de 50% a 70% de adesão.Conclusão:as principais medidas preventivas constantes na literatura são utilizadas na prática clínica pelos enfermeiros, e estes demonstram boa adesão sobre os cuidados imprescindíveis para a prevenção da Pneumonia Associada à Ventilação Mecânica (AU).

Introduction:Ventilator-AssociatedPneumoniais the most important and common infection that affects patients on mechanical ventilation. Furthermore, it is considered a serious hospital health problem,with worrying morbidity and mortality rates.Objective:to investigate in the literature which are the main nursing actions for the prevention of Ventilator-Associated Pneumonia. Methodology:this is an integrative literature review study. After using the PICO strategy, the following guiding questionwas defined: "What are the main nursing interventions for preventingVentilator-Associated Pneumonia?". After reading and applying the selection criteria, nine articles were used. Results:the main nursing interventions described were elevation of the headboardbetween 30-45 degrees, maintaining cuff pressure between 20 and 30 cmH2O, oral hygiene with 0.12%chlorhexidine, hand hygiene, suctionof secretions and daily interruption of sedation. Regarding professional adherence, most interventions reached 50% to 70% adherence. Conclusion:the main preventive measures listed in the literature are used in clinical practice by nurses,and they demonstrate good adherence to essential care for the prevention of Ventilator-Associated Pneumonia (AU).

Introducción:la Neumonía Asociada a Ventilación Mecánica es la infección más importante y común que afecta a los pacientes que recibenventilación mecánica. Asimismo, se considera un grave problema de salud hospitalaria,con preocupantes tasas de morbimortalidad.Objetivo: investigar en la literatura cuáles son las principales acciones de enfermería para la prevención de la Neumonía Asociada a Ventilación Mecánica. Metodología:se trata de un estudio de revisión integrativade la literatura. Después de utilizar la estrategia PICO, se definió la siguiente pregunta orientadora: "¿Cuáles son las principales intervenciones de enfermería para la prevención de la Neumonía Asociada a Ventilación Mecánica?".Luegode la lectura y aplicación de los criterios de selección, se utilizaron nueve artículos. Resultados:las principales intervenciones de enfermería descritas fueron elevarla cabeceraentre 30-45 grados, mantenerla presión del manguito entre 20 y 30 cmH2O, higiene bucal conclorhexidina al 0,12%, higiene de manos, aspiración de secreciones e interrupción diaria de la sedación.En cuanto a la adherencia profesional, la mayoría de las intervenciones alcanzaron entre un 50% y un70% de adherencia. Conclusión:las principales medidas preventivas contenidas en la literatura son utilizadas en la práctica clínica por los enfermeros,y muestran una buena adherencia a los cuidados esenciales para la prevención de la Neumonía Asociada a Ventilación Mecánica (AU).

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Ventilator-associated pneumonia (VAP) is one of the most common causes of nosocomial infections. The aim of this study was to evaluate the antimicrobial and anti-biofilm activity of an in-house low-cost tracheostomy tube impregnated with chlorhexidine and violet crystal. The impregnated tracheostomy tubes demonstrated antimicrobial activity, including for multidrug-resistant bacteria. Fourteen patients were evaluated. During ventilation, VAP occurred in one patient in the coated group and in three patients in the control group (p=0.28). A reduction of biofilm cells was observed. This study provides preliminary evidence to support that the antiseptic impregnation of a tracheostomy tube provides significant antimicrobial activity.

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INTRODUCTION: Health care-associated infections (HAIs) contribute to morbidity and mortality and to the dissemination of multidrug-resistant organisms. Children admitted to the intensive care unit undergo invasive procedures that increase their risk of developing HAIs and sepsis. The aim of the study was to analyse factors associated with mortality due to sepsis arising from HAIs. PATIENTS AND METHODS: We conducted a case-control study in a 7-bed multipurpose paediatric intensive care unit in a tertiary care teaching hospital. The sample consisted of 90 children admitted between January 2014 and December 2018. The case group consisted of patients who died from sepsis associated with the main health care-associated infections; the control group consisted of patients who survived sepsis associated with the same infections. RESULTS: Death was associated with age less than or equal to 12 months, presence of comorbidity, congenital disease, recurrent ventilator-associated pneumonia and septic shock. In the multiple regression analysis, heart disease (OR, 12.48; CI 2.55-60.93; P = .002), infection by carbapenem-resistant bacteria (OR, 31.51; CI 4.01-247.25; P = .001), cancer (OR, 58.23; CI 4.54-746.27; P = .002), and treatment with adrenaline (OR, 13.14; CI 1.35-128.02; P = .003) continued to be significantly associated with death. CONCLUSIONS: Hospital sepsis secondary to carbapenem-resistant bacteria contributed to a high mortality rate in this cohort. Children with heart disease or neoplasia or who needed vasopressor drugs had poorer outcomes.

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INTRODUCTION: Ventilator-associated pneumonia (VAP) presents a significant challenge in intensive care units (ICUs). Nebulized antibiotics, particularly colistin and tobramycin, are commonly prescribed for VAP patients. However, the appropriateness of using inhaled antibiotics for VAP remains a subject of debate among experts. This study aims to provide updated insights on the efficacy of adjunctive inhaled colistin and tobramycin through a comprehensive systematic review and meta-analysis. METHODS: A thorough search was conducted in MEDLINE, EMBASE, LILACS, COCHRANE Central, and clinical trials databases ( www. CLINICALTRIALS: gov ) from inception to June 2023. Randomized controlled trials (RCTs) meeting specific inclusion criteria were selected for analysis. These criteria included mechanically ventilated patients diagnosed with VAP, intervention with inhaled Colistin and Tobramycin compared to intravenous antibiotics, and reported outcomes such as clinical cure, microbiological eradication, mortality, or adverse events. RESULTS: The initial search yielded 106 records, from which only seven RCTs fulfilled the predefined inclusion criteria. The meta-analysis revealed a higher likelihood of achieving both clinical and microbiological cure in the groups receiving tobramycin or colistin compared to the control group. The relative risk (RR) for clinical cure was 1.23 (95% CI: 1.04, 1.45), and for microbiological cure, it was 1.64 (95% CI: 1.31, 2.06). However, there were no significant differences in mortality or the probability of adverse events between the groups. CONCLUSION: Adjunctive inhaled tobramycin or colistin may have a positive impact on the clinical and microbiological cure rates of VAP. However, the overall quality of evidence is low, indicating a high level of uncertainty. These findings underscore the need for further rigorous and well-designed studies to enhance the quality of evidence and provide more robust guidance for clinical decision-making in the management of VAP.

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Introduction: Cervical spinal cord injury (CSCI) patients on mechanical ventilation often lack standardized guidelines for optimal ventilatory support. This study reviews existing literature to compare outcomes between high tidal volume (HTV) and low tidal volume (LTV) strategies in this unique patient population. Methods: We searched for studies published up to August 30, 2023, in five databases, following a PECO/PICO strategy. We found six studies for quantitative analysis and meta-analyzed five studies. Results: This meta-analysis included 396 patients with CSCI and mechanical ventilation (MV), 119 patients treated with high tidal volume (HTV), and 277 with low tidal volume (LTV). This first meta-analysis incorporates the few studies that show contradictory findings. Our meta-analysis shows that there is no significant statistical difference in developing VAP between both comparison groups (HTV vs. LTV) (OR 0.46; 95% CI 0.13 to 1.66; p > 0.05; I2: 0%), nor are there differences between the presence of other pulmonary complications when treating with HTV such as acute respiratory distress syndrome (ARDS), atelectasis, onset of weaning. Conclusion: In patients with CSCI in MV, the use of HTV does not carry a greater risk of pneumonia compared to LTV; in turn, it is shown as a safe ventilatory strategy as it does not establish an increase in other pulmonary complications such as ARDS, atelectasis, the onset of weaning nor others associated with volutrauma. It is necessary to evaluate the role of HTV ventilation in this group of patients in primary RCT-type studies.

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Acinetobacter pneumonia is a significant healthcare-associated infection that poses a considerable challenge to clinicians due to its multidrug-resistant nature. Recent world events, such as the COVID-19 pandemic, have highlighted the need for effective treatment and management strategies for Acinetobacter pneumonia. In this review, we discuss lessons learned from recent world events, particularly the COVID-19 pandemic, in the context of the treatment and management of Acinetobacter pneumonia. We performed an extensive literature review to uncover studies and information pertinent to the topic. The COVID-19 pandemic underscored the importance of infection control measures in healthcare settings, including proper hand hygiene, isolation protocols, and personal protective equipment use, to prevent the spread of multidrug-resistant pathogens like Acinetobacter. Additionally, the pandemic highlighted the crucial role of antimicrobial stewardship programs in optimizing antibiotic use and curbing the emergence of resistance. Advances in diagnostic techniques, such as rapid molecular testing, have also proven valuable in identifying Acinetobacter infections promptly. Furthermore, due to the limited availability of antibiotics for treating infections caused A. baumannii, alternative strategies are needed like the use of antimicrobial peptides, bacteriophages and their enzymes, nanoparticles, photodynamic and chelate therapy. Recent world events, particularly the COVID-19 pandemic, have provided valuable insights into the treatment and management of Acinetobacter pneumonia. These lessons emphasize the significance of infection control, antimicrobial stewardship, and early diagnostics in combating this challenging infection.

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Background and objective: The many patients who develop ventilator-associated pneumonia (VAP) have generated numerous VAP survivors who are not followed up in the long term. This study aimed, primarily, to evaluate the long-term functional capacity, as measured using the Glittre-ADL test (TGlittre), of VAP survivors and, secondarily, to calculate the correlations of TGlittre with muscle and lung function. Methods: This cross-sectional study evaluated 30 VAP survivors 10 months after discharge from the intensive care unit. The participants underwent the following assessments: TGlittre; respiratory muscle strength; handgrip strength (HGS); spirometry; Functional Assessment of Chronic Therapy (FACIT-F); and Short Form-36 (SF-36). Results: The median TGlittre time was 95 (81-130)% of predicted, and 30 % of the participants performed poorly on TGlittre. One-third of the participants had abnormal spirometry results. TGlittre time was correlated with weight (rs = -0.412, P = 0.023), body index mass (BMI, rs = -0.400, P = 0.029), forced vital capacity (FVC, rs = -0.401, P = 0.030), HGS (rs = -0.571, P = 0.0009), FACIT-F score (rs = -0.405, P = 0.026), and different SF-36 domain scores. Participants who returned to work had a shorter TGlittre time than those who did not (89 (69-104) vs. 129 (102-183)% predicted). Multiple linear regression indicated that FVC and BMI explained 39 % of TGlittre variability. Conclusion: VAP survivors had suboptimal functional capacity, low lung function, and general fatigue 10 months after discharge. The longer the TGlittre time was, the worse the lung function, muscle function, general fatigue, and quality of life were and the less likely the patient was to have returned to work.

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Introducción: los pacientes con COVID-19 ingresan en mayor proporción a asistencia respiratoria mecánica, aumentando: el riesgo de neumonía asociada a ventilador (NAV) las tasas de mortalidad, los días de permanencia en las unidades de terapia intensiva (UCI) y los costos sanitarios. Objetivo: determinar la Mortalidad intrahospitalaria de pacientes con COVID-19 complicados con neumonías bacterianas en asistencia respiratoria mecánica en Cuidados Intensivos de Adultos en un Hospital del Paraguay durante los años 2020 a 2021. Metodología: estudio analítico de tipo cohorte retrospectiva. Se registraron variables demográficas, comorbilidades, puntajes en scores de gravedad como el APACHE II al ingreso, la cifra más baja de oxigenación durante la internación expresado por la PaO2 / FIO2, días de ventilación, colocación en decúbito prono, traqueotomía, medidas terapéuticas farmacológicas y no farmacológicas, días de internación, así como las complicaciones y la mortalidad. Resultados: fueron incluidos 214 pacientes, 135 ingresaron a asistencia respiratoria mecánica (ARM) de los cuales 58 (42,9 %) desarrollaron NAV, con edad mediana de 52 años (40-60). Los microorganismos de NAV fueron cocos Gram negativos en 98,3 %, incluyendo Acinetobacter baumanii en 46,5 %, Klebsiella pneumoniae en 22,8 %, Pseudomona aeruginosa en 15,5 % y 5,2 % Stenotrophomona maltofilia. La mortalidad intrahospitalaria fue del 44,8 %. Los menores de 50 años tienen una sobrevida mayor que los mayores (34 días vs 22 días, con p de 0,026). Conclusión: la mortalidad intrahospitalaria fue del 44,8 %. La edad fue un factor de riesgo independiente para la mortalidad en pacientes con NAV, por lo que los profesionales de la salud deben estar atentos a la posibilidad de NAV en pacientes que requieren asistencia respiratoria mecánica, especialmente en pacientes mayores de 50 años.

Introduction: patients with COVID-19 are more likely to require mechanical ventilation, which increases the risk of ventilator-associated pneumonia (VAP), mortality rates, length of stay in intensive care units (ICUs), and healthcare costs. Objective: to determine the in-hospital mortality of patients with COVID-19 complicated by bacterial pneumonia on mechanical ventilation in Adult Intensive Care in a Hospital in Paraguay during the years 2020 to 2021. Methodology: this is a retrospective cohort analytical study. Demographic variables, comorbidities, severity scores such as APACHE II on admission, the worst oxygenation during hospitalization expressed by PaO2/FiO2, days of ventilation, prone position, tracheostomy, pharmacological and non-pharmacological therapeutic measures, days of hospitalization, as well as complications and mortality were recorded. Results: a total of 214 patients were included, 135 were admitted to mechanical ventilation (MRA), of which 58 (42.9%) developed VAP, with a median age of 52 years (40-60). VAP microorganisms were Gram-negative cocci in 98.3%, including Acinetobacter baumanii in 46.5%, Klebsiella pneumoniae in 22.8%, Pseudomona aeruginosa in 15.5%, and Stenotrophomona maltophilia in 5.2%. In-hospital mortality was 44.8%. Those under 50 years of age have a longer survival than those older (34 days vs. 22 days, with p of 0.026). Conclusion: the overall mortality rate was 44.8%. Age was an independent risk factor for mortality in patients with VAP, so healthcare professionals should be aware of the possibility of VAP in patients who require mechanical ventilation, especially in patients over 50 years of age.

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BACKGROUND: Healthcare-associated infections (HAIs) have a significant impact on patients' morbidity and mortality, and have a detrimental financial impact on the healthcare system. Various strategies exist to prevent HAIs, but economic evaluations are needed to determine which are most appropriate. AIM: To present the financial impact of a nationwide project on HAI prevention in intensive care units (ICUs) using a quality improvement (QI) approach. METHODS: A health economic evaluation assessed the financial results of the QI initiative 'Saúde em Nossas Mãos' (SNM), implemented in Brazil between January 2018 and December 2020. Among 116 participating institutions, 13 (11.2%) fully reported the aggregate cost and stratified patients (with vs without HAIs) in the pre-intervention and post-intervention periods. Average cost (AC) was calculated for each analysed HAI: central-line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CAUTIs). The absorption model and time-driven activity-based costing were used for cost estimations. The numbers of infections that the project could have prevented during its implementation were estimated to demonstrate the financial impact of the SNM initiative. RESULTS: The aggregated ACs calculated for each HAI from these 13 ICUs - US$8480 for CLABSIs, US$10,039 for VAP, and US$7464 for CAUTIs - were extrapolated to the total number of HAIs prevented by the project (1727 CLABSIs, 3797 VAP and 2150 CAUTIs). The overall savings of the SNM as of December 2020 were estimated at US$68.8 million, with an estimated return on investment (ROI) of 765%. CONCLUSION: Reporting accurate financial data on HAI prevention strategies is still challenging in Brazil. These results suggest that a national QI initiative to prevent HAIs in critical care settings is a feasible and value-based approach, reducing financial waste and yielding a significant ROI for the healthcare system.

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Lean healthcare visual management has been successfully integrated into infection control programs, leading to lower healthcare-associated infection (HAI) rates and greater provider compliance with evidence-based prevention practices; however, its implementation during quality improvement (QI) initiatives in limited-resource settings has not yet been well exploited. We aimed to describe a low-cost strategy involving Kamishibai cards to sustain bundles' adherence to prevent HAIs in a middle-income country. This descriptive case study evaluated the implementation of a lean healthcare visual management tool-Kamishibai board (K-board)-during a nationwide QI collaborative preventing three critical HAIs in 189 adult and pediatric/neonatal intensive care units (ICUs) from September 2021 to January 2023. Considering a limited-resource setting, our team adapted a K-board using simple, cheap, and easy-to-handle materials for routine monitoring of QI procedures, including safety bundles' compliance. After test prototypes, the final K-board version was implemented. The chart materials and assembly cost BRL 80.00 (USD 15.48). Before launching, expert working group meetings were held to shape the contents, refine technical issues, and prepare the ICU teams for implementation. After starting, plan-do-study-act cycles were conducted according to the Breakthrough Series model. Participating ICU teams, including leaders and front-line health workers, performed bedside audits following a weekly chronogram. Two indicators were calculated: the percentage of ICUs in which K-boards were being implemented and whether bundles' compliance was addressed in the K-board. Audit data were recorded in 'SimpleQI'. After 17 months of this initiative, 177 (93.7%) participating ICUs had included this visual management tool in their daily care routines. When more than 94 (>50%) ICUs posted K-board data, the mean compliance for the bundles for each HAI was sustained above 85%. A lean healthcare visual management tool can be adapted to local settings, including healthcare facilities with limited resources. K-board seems to be a feasible method for auditing evidence-based practices in medical care, including safety bundles to simultaneously prevent three types of HAIs.

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INTRODUCTION: Understanding the presence and function of a diverse lung microbiome in acute lung infections, particularly ventilator-associated pneumonia (VAP), is still limited, evidencing significant gaps in our knowledge. AREAS COVERED: In this comprehensive narrative review, we aim to elucidate the contribution of the respiratory microbiome in the development of VAP by examining the current knowledge on the interactions among microorganisms. By exploring these intricate connections, we endeavor to enhance our understanding of the disease's pathophysiology and pave the way for novel ideas and interventions in studying the respiratory tract microbiome. EXPERT OPINION: The conventional perception of lungs as sterile is deprecated since it is currently recognized the existence of a diverse microbial community within them. However, despite extensive research on the role of the respiratory microbiome in healthy lungs, respiratory chronic diseases and acute lung infections such as pneumonia are not fully understood. It is crucial to investigate further the relationship between the pathophysiology of VAP and the pulmonary microbiome, elucidating the mechanisms underlying the interactions between the microbiome, host immune response and mechanical ventilation for the development of VAP.

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This study aimed to explore the molecular epidemiology of Staphylococcus aureus isolated from patients on mechanical ventilation and the participation of virulence factors in the development of ventilator-associated pneumonia (VAP). A prospective cohort study was conducted on patients under mechanical ventilation, with periodic visits for the collection of tracheal aspirates and clinical data. The S. aureus isolates were analyzed regarding resistance profile, virulence, expression of protein A and alpha-toxin using Western blot, clonal profile using PFGE, sequence type using MLST, and characterization and quantification of phenol-soluble modulins. Among the 270 patients in the study, 51 S. aureus strains were isolated from 47 patients. The incidence density of S. aureus and MRSA VAP was 2.35/1000 and 1.96/1000 ventilator days, respectively; of these, 45% (n = 5) were resistant to oxacillin, with 100% (n = 5) harboring SCCmec types II and IV. The most frequent among the tested virulence factors were icaA, hla, and hld. The clonal profile showed a predominance of sequence types originating from the community. Risk factors for VAP were the presence of solid tumors and the sea gene. In conclusion, patient-related risk factors, together with microbiological factors, are involved in the development of S. aureus VAP, which is caused by the patient's own strains.

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BACKGROUND: Ventilator-Associated pneumonia (VAP) is one of the leading causes of morbidity and mortality in critically ill COVID-19 patients in lower-and-middle-income settings, where timely access to emergency care and accurate diagnostic testing is not widely available. Therefore, rapid microbiological diagnosis is essential to improve effective therapy delivery to affected individuals, preventing adverse outcomes and reducing antimicrobial resistance. METHODS: We conducted a cross-sectional study of patients with suspected VAP and COVID-19, evaluating the diagnostic performance of the BioFire® FilmArray® Pneumonia Panel (FA-PP). Respiratory secretion samples underwent standard microbiological culture and FA-PP assays, and the results were compared. RESULTS: We included 252 samples. The traditional culture method detected 141 microorganisms, and FA-PP detected 277, resulting in a sensitivity of 95% and specificity of 60%, with a positive predictive value of 68% and negative predictive value of 93%. In samples with high levels of genetic material (> 10^5 copies/mL), the panel had a sensitivity of 94% and specificity of 86%. In addition, 40% of the culture-negative samples had positive FA-PP® results, of which 35% had > 10^5 copies/mL of genetic material. The most prevalent bacteria were Gram-negative bacilli, followed by Gram-positive cocci. The panel identified 98 genes associated with antimicrobial resistance, predominantly extended-spectrum beta-lactamases (28%). CONCLUSION: The FA-PP is a sensitive assay for identifying bacteria causing VAP in patients with COVID-19, with a greater capacity to detect bacteria than the conventional method. The timely microbiological recognition offered by this panel could lead to optimized decision-making processes, earlier tailored treatment initiation, and improved antibiotic stewardship practices.

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INTRODUCTION: Risk factors and postoperative complications can worsen the condition of patients undergoing coronary artery bypass grafting; some of these factors and complications are closely related to mortality rate. OBJECTIVE: To describe clinical factors and outcomes related to mortality of patients undergoing coronary artery bypass grafting and on invasive mechanical ventilation. METHODS: This is a single-center retrospective data analysis of patients who underwent coronary artery bypass grafting on invasive mechanical ventilation between 2013 and 2019. Data regarding clinical characteristics, postoperative complications, intensive care unit and mechanical ventilation time, and their relationship with mortality were analyzed. RESULTS: Four hundred seventy-two patients who underwent coronary artery bypass grafting entered the study. Their mean age was 62.3 years, and mean body mass index was 27.3. The mortality rate was 4%. Fifty percent of the patients who had ventilator-associated pneumonia died. Considering the patients who underwent hemotherapy and hemodialysis, 20% and 33% died, respectively. Days of intensive care unit stay and high Acute Physiology and Chronic Health Evaluation score and Simplified Acute Physiology Score were significantly related to death. CONCLUSION: Factors and clinical conditions such as the patients' age, associated comorbidities, the occurrence of ventilator-associated pneumonia, length of stay in the intensive care unit, and mechanical ventilation time are related to higher mortality in patients undergoing coronary artery bypass grafting.

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BACKGROUND: Nosocomial pneumonia ranks among the top 5 diseases that lead to additional financial costs due to hospitalization. This study aimed to evaluate the cost of oral care and its clinical effectiveness in preventing pneumonia in a systematic review. METHODS: The search was conducted in the following databases: PubMed, Cochrane Library, Web of Sciences, Scopus, CINAHL, LILACS, complemented by gray literature and manual search, between January/2021 and August/2022. Two independent reviewers extracted data from the selected articles, individually analyzing each study's quality using the BMJ Drummond checklist. The data were tabulated by clinical or economic type. RESULTS: A total of 3,130 articles were identified; the eligibility criteria were verified, and 12 articles were selected for qualitative analysis. Only 2 achieved satisfactory quality assessment for economic analysis studies. There was heterogeneity between clinical and economic data. Eleven of the 12 studies reported a decrease in the incidence of nosocomial pneumonia following the application of oral care practices. Most authors reported a reduction in the estimate of individual costs, followed by a decrease in the need for antibiotic therapy. The costs of oral care were very low compared to other costs. CONCLUSIONS: Despite the low level of evidence in the literature, heterogeneity and poor quality of the selected studies, most studies concluded that oral care seemed to lead to reduced costs in hospital expenses for treating pneumonia.

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Background: Traumatic brain injury (TBI) is a public health problem with a high burden in terms of disability and death. Infections are a common complication, with respiratory infections being the most frequent. Most available studies have addressed the impact of ventilator-associated pneumonia (VAP) after TBI; therefore, we aim to characterize the hospital impact of a broader entity, lower respiratory tract infections (LRTIs). Methods: This observational, retrospective, single-center cohort study describes the clinical features and risk factors associated with LRTIs in patients with TBI admitted to an intensive care unit (ICU). We used bivariate and multivariate logistic regressions to identify the risk factors associated with developing LRTI and determine its impact on hospital mortality. Results: We included 291 patients, of whom 77% (225/291) were men. The median (IQR) age was 38 years (28-52 years). The most common cause of injury was road traffic accidents 72% (210/291), followed by falls 18% (52/291) and assault at 3% (9/291). The median (IQR) Glasgow Coma Scale (GCS) score on admission was 9 (6-14), and 47% (136/291) were classified as severe TBI, 13% (37/291) as moderate TBI, and 40% (114/291) as mild TBI. The median (IQR) injury severity score (ISS) was 24 (16-30). Nearly 48% (141/291) of patients presented at least one infection during hospitalization, and from those, 77% (109/141) were classified as LRTIs, which included tracheitis 55% (61/109), ventilator-associated pneumonia (VAP) 34% (37/109), and hospital-acquired pneumoniae (HAP) 19% (21/109). After multivariable analysis, the following variables were significantly associated with LRTIs: age (OR 1.1, 95% CI 1.01-1.2), severe TBI (OR 2.7, 95% CI 1.1-6.9), AIS thorax (OR 1.4, 95 CI 1.1-1.8), and mechanical ventilation on admission (OR 3.7, 95% CI 1.1-13.5). At the same time, hospital mortality did not differ between groups (LRTI 18.6% vs. No LRTI 20.1%, p = 0.7), and ICU and hospital length of stay (LOS) were longer in the LRTI group (median [IQR] 12 [9-17] vs. 5 [3-9], p < 0.01) and (median [IQR] 21 [13-33] vs. 10 [5-18], p = 0.01), respectively. Time on the ventilator was longer for those with LRTIs. Conclusion: The most common site/location of infection in patients with TBI admitted to ICU is respiratory. Age, severe TBI, thoracic trauma, and mechanical ventilation were identified as potential risk factors. LRTI was associated with prolonged ICU, hospital stay, and more days on a ventilator, but not with mortality.

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INTRODUCTION: Pseudomonas aeruginosa respiratory infections are challenging, and the risk of recurrence is a frequent problem. The aim of this study was to investigate the risk factors associated with the presence of P. aeruginosa, and the risk factors related to the recurrence and death of lower airway infections in inpatients in a Brazilian hospital. METHODS: Retrospective cohort with inpatients that had a sample of airways culture (tracheal aspirate or bronchoalveolar lavage) with the detection of P. aeruginosa. The patients with clinical criteria of infection were classified as ventilator-associated, hospital-acquired, or community-acquired pneumonia. P. aeruginosa in respiratory samples without symptoms was considered colonization. The antimicrobial treatment adequacy and the clinical data were evaluated. Outcome variables included mortality and recurrence. RESULTS: One hundred and fifty-four patients were included in the study, most of them were men, and the majority (102) were considered infected. The average length of stay was superior to 30 days. Previous pulmonary disease was associated with the occurrence of colonization. Aminoglycosides were the most active drug according to susceptibility tests and were successfully used as monotherapy. Septic shock was a risk factor for death in the infected patients. The use of adequate antimicrobial therapy was associated with major survival, independent of the infection classification. CONCLUSION: It is possible to evaluate clinical data associated with recurrence and mortality in patients with different lung infections by P. aeruginosa. Aminoglycoside monotherapy is safe and effective in P. aeruginosa respiratory infections.

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Background: Although there are simple and low-cost measures to prevent healthcare-associated infections (HAIs), they remain a major public health problem. Quality issues and a lack of knowledge about HAI control among healthcare professionals may contribute to this scenario. In this study, our aim is to present the implementation of a project to prevent HAIs in intensive care units (ICUs) using the quality improvement (QI) collaborative model Breakthrough Series (BTS). Methods: A QI report was conducted to assess the results of a national project in Brazil between January 2018 and February 2020. A 1-year preintervention analysis was conducted to determine the incidence density baseline of the 3 main HAIs: central line-associated bloodstream infections (CLABSIs), ventilation-associated pneumonia (VAP), and catheter-associated urinary tract infections (CA-UTIs). The BTS methodology was applied during the intervention period to coach and empower healthcare professionals providing evidence-based, structured, systematic, and auditable methodologies and QI tools to improve patients' care outcomes. Results: A total of 116 ICUs were included in this study. The 3 HAIs showed a significant decrease of 43.5%, 52.1%, and 65.8% for CLABSI, VAP, and CA-UTI, respectively. A total of 5140 infections were prevented. Adherence to bundles inversely correlated with the HAI incidence densities: CLABSI insertion and maintenance bundle (R = -0.50, P = .010 and R = -0.85, P < .001, respectively), VAP prevention bundle (R = -0.69, P < .001), and CA-UTI insertion and maintenance bundle (R = -0.82, P < .001 and R = -0.54, P = .004, respectively). Conclusions: Descriptive data from the evaluation of this project show that the BTS methodology is a feasible and promising approach to preventing HAIs in critical care settings.

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Fundamento: La salud bucal y sus cuidados son importantes en la atención sanitaria de pacientes en estado crítico. Objetivo: Proporcionar una visión general de los vínculos entre la salud bucal y los resultados adversos en la evolución de los pacientes en estado crítico. Metodología: Esta revisión narrativa se realizó en Google Académico, PubMed/Medline y SciELO, con los descriptores salud bucal, cuidados críticos, respiración artificial y neumonía asociada al ventilador, consultados en el DeCS. Se seleccionaron artículos a texto completo en español e inglés de revistas arbitradas por pares y de los últimos 5 años. Resultados: La disbiosis y la mala higiene bucales propician la aparición y desarrollo de enfermedades bucales que, a su vez, favorecen la incidencia de enfermedades respiratorias bajas como la neumonía asociada al ventilador en pacientes en estado crítico. Dentro de los factores vinculantes están la aspiración de secreciones bucales con bacterias patógenas que colonizan el tracto respiratorio inferior y los trastornos nutricionales que reducen el sistema defensivo. Aunque existen algunas discrepancias, la mayoría de los estudios apoyan las medidas de cuidado bucal en los pacientes en estado crítico. Conclusiones: La salud y cuidados bucales son claves para un desenlace clínico más favorable en los pacientes en estado crítico.

Background: Oral health and oral health care are important in the health care of critically ill patients. Objective: To provide an overview of the relationship between oral health and adverse outcomes in critically ill patients. Methodology: This narrative revision was conducted in Google Scholar, PubMed/Medline and SciELO, with the descriptors oral health, critical care, artificial respiration and ventilator-associated pneumonia consulted in the DeCS. Full-text articles in Spanish and English from peer-reviewed journals and from the last 5 years were selected. Results: Dysbiosis and poor oral hygiene promote the incidence and development of oral diseases, which in turn promote the incidence of lower respiratory system diseases such as ventilator-associated pneumonia in critically ill patients. Among the factors involved are aspiration of oral secretions with pathogenic bacteria that colonize the lower respiratory tract, and nutritional deficiencies that compromise the immune system. Although there are some discrepancies, most studies support oral care practices in critically ill patients. Conclusions: The health and care of the oral cavity is the key to a more favorable outcome for critically ill patients.

RESUMO

AIMS: To verify whether oral health teams influence the oral health status, ventilator-associated pneumonia incidence and mortality rate of patients in Intensive Care Units (ICU). MATERIALS AND METHODS: Bibliographic searches were performed in PubMed, Scopus, Web of Science, Lilacs, Embase, Livivo, Open Grey, Academic Google, and Cochrane databases. The assessment of the methodological quality and risk of bias of the included studies and a random-effects meta-analysis to summarize relative risk data for ventilator-associated pneumonia (VAP) and mortality were performed. An analysis of the certainty of the evidence was performed for the main outcomes analyzed. RESULTS: Records of 518 studies were analyzed by reading titles and abstracts. Five studies were included according to eligibility criteria. The meta-analysis showed that ICU patients undergoing dental care by an oral health team had a lower incidence of VAP (OR = 0.33; 95% CI: 014-0.76) but did not lower mortality rates (OR = 0.46 95% CI: 0.16-1.32). The certainty of the evidence was considered very low. CONCLUSION: Dental care provided by oral health teams in a hospital environment did not influence oral health status or mortality, although it contributed to a reduction in VAP of patients admitted to the ICU.