Introduction: Mechanical ventilation-associated pneumonia (VAP) is the second most frequent nosocomial infection in paediatric intensive care units in patients undergoing mechanical ventilation for ≥ 48h. The incidence varies between 5% and 40% and the mortality risk between 30% and 70%. The main reasons for the use of mechanical ventilation are prematurity and related complications, perinatal asphyxia, pulmonary causes other than respiratory distress syndrome (RDS), and congenital heart disease. The main pathogens responsible for the development of VAP are Gram-negative bacteria. Aim: The aim of the study is to analyze the occurrence of VAP in pediatric intensive care settings with the aim of identifying risk factors and the most effective care strategies for the management and prevention of pneumonia through clinical adjustments in daily nursing practice. Materials and Methods: A Scoping Review was conducted, 117 articles retrieved from PubMed, Cochrane Library and Ebsco were initially selected, and 18 articles were found to be eligible and relevant for the study. Results: The results show that VAP prevention involves the application of nursing bundles and emphasise the importance of controlling risk factors. Discussion: The study focuses on the points of greatest disagreement in the literature. They mainly discuss the diagnosis of VAP, mode of endotracheal aspiration, main pathogens and the correlation between prematurity at birth and the development of VAP. Conclusion: In conclusion, VAP is the second most frequent nosocomial infection in paediatric intensive care units. The main bacteria responsible for pneumonia are Gramnegatives with an increased presence of Gram-positives. A prevention plan is essential to reduce the incidence of VAP. Keywords: Pneumonia, artificial respiration, epidemiology, mechanical ventilation, pathophysiology, prevention, risk factors, pneumonia associated ventilation, endotracheal suction, infant.
Introduzione: La polmonite associata a ventilazione meccanica (VAP) è la seconda infezione nosocomiale più frequente nelle unità di terapia intensiva pediatrica che sviluppano i pazienti sottoposti a ventilazione meccanica per un tempo ≥ 48h. L’incidenza varia dal 5% al 40% e il rischio di mortalità tra il 30% e il 70%. Le principali motivazioni per l’utilizzo della ventilazione meccanica sono legate alla prematurità e alle relative complicanze, all’asfissia perinatale, alle cause polmonari differenti dalla sindrome di distress respiratorio (RDS), alle cardiopatie congenite. I principali patogeni responsabili dello sviluppo della VAP sono i batteri Gram-negativi. Obiettivo: L’obiettivo dello studio è quello di analizzare l’insorgenza della VAP nei setting di terapia intensive pediatrica con lo scopo di identificare i fattori di rischio e le strategie assistenziali più efficaci per la gestione e la prevenzione della polmonite mediante adeguamenti clinici nella pratica infermieristica quotidiana. Materiali e metodi: E’ stata condotta una Scoping Review, sono stati selezionati inizialmente 117 articoli reperiti da PubMed, Cochrane Library ed Ebsco e gli articoli risultati eleggibili e pertinenti per lo studio sono stati 18. Risultati: I risultati ottenuti mostrano che la prevenzione alla VAP prevede l'applicazione di bundle infermieristici e sottolineano l'importanza del controllo dei fattori di rischio. Discussione: Lo studio verte sui punti di maggiore disaccordo in letteratura. Si parla principalmente di diagnosi di VAP, modalità di aspirazione endotracheale, agenti patogeni principali e la correlazione tra prematurità alla nascita e lo sviluppo di VAP. Conclusione: In conclusione, la VAP è la seconda infezione nosocomiale più frequente nelle unità di terapia intensiva pediatrica. I batteri principali responsabili della polmonite sono i Gram-negativi con un aumento della presenza dei Gram-positivi. È indispensabile un piano di prevenzione per ridurre l’incidenza della VAP. Parole chiavi: Pneumonia, artificial respiration, epidemiology, mechanical ventilation, pathophysiology, prevention, risk factors, pneumonia associated ventilation, endotracheal suction, infant.
Gestione e prevenzione delle polmoniti da ventilazione meccanica (VAP) in un setting assistenziale intensivo pediatrico: una scoping review
CANTILENO, ANNA MARIA
2022/2023
Abstract
Introduction: Mechanical ventilation-associated pneumonia (VAP) is the second most frequent nosocomial infection in paediatric intensive care units in patients undergoing mechanical ventilation for ≥ 48h. The incidence varies between 5% and 40% and the mortality risk between 30% and 70%. The main reasons for the use of mechanical ventilation are prematurity and related complications, perinatal asphyxia, pulmonary causes other than respiratory distress syndrome (RDS), and congenital heart disease. The main pathogens responsible for the development of VAP are Gram-negative bacteria. Aim: The aim of the study is to analyze the occurrence of VAP in pediatric intensive care settings with the aim of identifying risk factors and the most effective care strategies for the management and prevention of pneumonia through clinical adjustments in daily nursing practice. Materials and Methods: A Scoping Review was conducted, 117 articles retrieved from PubMed, Cochrane Library and Ebsco were initially selected, and 18 articles were found to be eligible and relevant for the study. Results: The results show that VAP prevention involves the application of nursing bundles and emphasise the importance of controlling risk factors. Discussion: The study focuses on the points of greatest disagreement in the literature. They mainly discuss the diagnosis of VAP, mode of endotracheal aspiration, main pathogens and the correlation between prematurity at birth and the development of VAP. Conclusion: In conclusion, VAP is the second most frequent nosocomial infection in paediatric intensive care units. The main bacteria responsible for pneumonia are Gramnegatives with an increased presence of Gram-positives. A prevention plan is essential to reduce the incidence of VAP. Keywords: Pneumonia, artificial respiration, epidemiology, mechanical ventilation, pathophysiology, prevention, risk factors, pneumonia associated ventilation, endotracheal suction, infant.| File | Dimensione | Formato | |
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Tesi Cantileno Anna Maria.pdf
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https://hdl.handle.net/20.500.12075/15816