Reducing the Risk of Ventilator-acquired Pneumonia - Research Paper Example

REDUCING THE RISK OF VENTILATION ACQUIRED PNEUMONIA al Affiliation) Introduction VAP mainly occur in patients who are ventilated. The adults that die because of acute respiratory diseases are those that die due to VAP. Ventilator-associated pneumonia is considered pneumonia in a patient in the support of ventilator for a period of more than 48 hours. A semi-upright posture in those that are in ventilated areas is recommenced to prevent ventilator-associated pneumonia (Keeley, 2007). Ventilator-associated pneumonia is a common intensive care that is recommended to reduce the infection. There are however arguments that have been risen that ventilator-associated pneumonia is able to reduce the risk of obtaining pneumonia. Ventilated patients have different factors that increase the chances of acquiring the disease. One of the main factors is aspiration of infected oral and gastric secretion. The main method used in the study involves the measure of the current degree of bed head evaluation in the trial that was in the ICU. There was measure of the degree of bed elevation measured on a random selection of patients with the use of a protractor and a plumb line. Two main trials have been undertaken to address the topic. The first study was by Drakulovic et al. (1999) that randomized participants through a list that was computer generated and divided the groups into a control unit and other at 45 degrees as the treatment group. The study was mainly involved in systematic review of the prevention of VAP. Van Nieuwenhoven et al. carried out the second trial in 2006, which attempted to replicate the study that had been done by Drakulovic. He randomized the ventilated patients to a supine position of 10 degrees head up and 45 degrees head up (Keeley, 2007). The patients used did volunteer for the study. The ethical permission was gained from the Trust and the Local Research Ethics Committee and was obtained from the patients and their next of kin. Data collection There are different factors that were considered in the research. The exclusion criteria include the previous intubation within the last 30 days, severe obese patient who were not in a position to tolerate head elevation to 45 degrees, recent abdominal surgery with vacuum dressing that needed change in the position of the patients to renew the dressing or gain a seal. The data collection also involved randomization of patients to treatment group of 45 degrees or to a control group at 25 degrees. The randomization by the nurses that recruited the patients through taking sealed opaque envelopes from a box that contained similar shuffled envelopes (Keeley, 2007). Nursing of the patients was done with one pillow beneath their heads with the effort of nurses making all the patients to have similar angle of head evaluation. The variables that were recorded in the study included pressure that was to track the use of inotropic therapy. This ensures that patients that were nursed at 45 degrees did not need additional support. The other variables that were recorded at the end of the research included the sex of the patients, the diagnosis of the patients whether surgical or medical, the white cell count, the temperature of the patients, ventilation, antibiotics, sedation score and Chronic Health Evaluation. The results of the study were taken after 72 hours after the study endpoint was reached. The research took a total period of 3.5 months. Data management and analysis The sets that were obtained in the research were analyzed with the help of assistance of statistician using Minilab computer package. The hypothesis used and the estimation procedures used from the study were the chi-square test for the association and the two sample t-test with confidence intervals (Keeley, 2007). The mean results were calculated from the data obtained and the data was checked for normal distribution to asset in the subsequent measures of central tendency and the significant test method were mathematically valid. At the points where data was normally distributed and the mean results were calculated. Parametric and non-parametric data analysis methods were used since that data contained both nominal, original and interval factors. The researcher bias was reduced in the study using chi-square test. The test was used since that data that was collected was minimal and they were not of an interval. The results and interpretations The data was collected for a period of 3.5 months. The resulting sample was a size of 54 patients. Due to the randomization, 29 on the patients were allocated to the treatment group and 25 being allocated the control group. Five of those that were kin to the treatment group developed VAP, four being confirmed and one was suspected of the condition. Seven of those that were in the control group developed VAP, five confirmed and two were suspected of the condition. Of the 12 patients that developed VAP, three of them were suspected as there was no positive microbiology in their specimen and nine were confirmed to have positive microbiology (Keeley, 2007). The morality of VAP patients was also determined and out of 12 patients that developed VAP, eight died. From the treatment group of five patients who developed VAP, four died. Three died in the ICU and one died after was discharged from the ward. Discussion The main aim of the study was to test on the hypothesis that there is a reduction in VAP when the patients that were ventilated to 45 degrees as compared to 25 degrees. Data that was collected over a period of 3.5 months that brought a patient number of 30. From the research, there are different factors that contributed to VAP. The studies that have been carried out have been notorious due to the number confrontation variables and the difficulty in accurate definition of VAP. There are clinical relevant differences in VAP rates between the two groups, though the difference was not statistically different. The small sample size that was used in the study was not efficient as it resulted in a type 2 error. An author Lowe, 1993 discussed the problems of over concern with the probability values in the results that were obtained. There are proportion alteration that should be taken to show the difference in the control group and the treatment group. The study should be taken in the treatment differences that were investigated and not because of the confronting variables in the patient’s premorbid state or in the treatment that they received that were unrelated to the study (Keeley, 2007). In the case of all confronting variables that were tested, there was no difference between the control and the treatment group. The limitation of the sample size that was used could be able to be overcome through prolonging the length of the study to include a large sample or through making the study multicenter. As described by Hubmayr (2002), the duration of mechanical ventilation of antibiotic exposure before the onset of VAP are considered some of the most important factors in the microbiology, incidence, and severity. Conclusion The findings show that the study did not provide sufficient evidence to support changing the clinical practice. The trend that is obtained from the research shows that a reduction in the incidence of VAP through the increase of angle of head evaluation from 25 to 45. The fact however needs further investigation. Reference Keeley, L. (2007). Reducing the risk of ventilator-acquired pneumonia through head of bed elevation. Nurs Crit Care, 12(6), 287-294. http://dx.doi.org/10.1111/j.1478-5153.2007.00247.x Read More