医学
呼吸机相关性肺炎
优势比
荟萃分析
机械通风
科克伦图书馆
重症监护室
肺炎
随机对照试验
置信区间
梅德林
观察研究
重症监护
内科学
重症监护医学
急诊医学
政治学
法学
作者
Raquel Martínez-Reviejo,Sofía Tejada,Miia Jansson,Alfonsina Ruiz-Spinelli,S Ramirez,Duygu Ege,Tarsila Vieceli,Bert Maertens,Stijn Blot,Jordi Rello
标识
DOI:10.1016/j.jointm.2023.04.004
摘要
Ventilator-associated pneumonia (VAP) represents a common hospital-acquired infection among mechanically ventilated patients. We summarized evidence concerning ventilator care bundles to prevent VAP. 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. 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. 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.
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