Prevention of Ventilation Case Study Solution
Synthesis:
Lin YJ etal.(2015)demonstrated an 8.5% reduction in the incidence of postoperative VAP with the use of 0.2% of chlorhexidine. Similarly, research by Claudia Fernanda et al. reported a reduction in the VAP incidence and length of ICU to stay by tooth-brushing with a 0.12 %CHG solution.Additionally, Bellissimo et al. demonstrated dental treatment with CHG an effective one as compared to oral hygiene supported with the use of sterile reusable equipment.
Thereby, researches have demonstrated the evidence of VAP incidence reduction rates based on RCTs with a reduction in the ICU stay length with the use of CHG.With the fact, almost every study represented 2 times the reduced incidence of VAP in the patients who are critically ill. Furthermore, other different concentrations are required to be evaluated for the complete elimination of VAP incidence.
Clinical Recommendation:
Preventive measures for VAP incidence have been reported under CDC clinical guidelines regarding the use of 0.12% CHG rinse during the pre-operative period. Further, the use of CHG solution of 0.12% should be considered as it significantly reduces the stay length in ICU. Additional research studies are required for evaluating whether daily CHGrinse can impact mortality despite a day before surgery with the possibility of VAP incidence reduction in Acute CU. However, oral CHG care is still debated due to its ineffectiveness in non-cardiac patients. (Jean-Francois Timsit, 2017)Additionally, the VAP bundle approach has known to effective against VAP incidents associated with mortality. (Dr. Gautam Rawal, 2018)Thus, essential nursing care is advocated for the prevention of dental plaque decolonization by the pathogens of respiratory tract infection for the prevention of VAP.
Appendix:
| Reference | Objective | Method | Sample | Outcome |
| (Lin YJ, 2015 ) | To study is to conduct a prospective randomized controlled trial for
Investigation of the effect of pre-operative 0.2% chlorhexidine on post-operative Ventilator-associated Pneumonia. |
1:1 randomization using computer-generated random numbers of the patients for cardiac surgery from August 2013 to April 2014. | · Total patients for heart surgery – N = 94 patients
· Randomized chlorhexidine group – n = 47 · Randomized control (saline) group – n = 47 |
The occurrence of VAP in the test group was 8.5% compared to 23.4% of the control group representing a significant reduction in the incidence of VAP. |
| (Claudia Fernanda de Lacerda Vidal, 2017) | To evaluate the efficacy of oral hygiene by tooth-brushing with 0.12% chlorhexidine solution as compared to oral hygiene only with chlorhexidine in adults under mechanical ventilation in ICU. | Randomization of patients by rolling dice using randomized observer-blind clinical trial from January 1, 2011, to August 8, 2013. | · Total patients in ICU – N = 716
· Control group using CHG with swab n=108 · Test group using CHG with toothbrushn=108 |
The study demonstrated a tendency to reduce the incidence of VAP and length of ICU stay by tooth-brushing with 0.12 %CHG solution. |
| (Bellissimo-Rodrigues WT, 2014) | To evaluate the enhancement of oral antisepsis through dental treatment leading to effective prevention of LRTIs. | Randomized trial July 2013 to January
2014 in three public hospital ICUs and one philanthropic ICU. |
· Total patients in ICU – N = 254
· Control oral hygiene group n=127 · Test dental care group n=127 |
The incidence of LRTIs was 8.7% tending dental treatment to be safe and effective in preventing the incidence of LRTIs in patients with at least 48 hours in ICU. |
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