The Effect of Manual Hyperinflation and Suctioning in Mechanically Ventilated Patients

Critically ill patients that require mechanical ventilation are at risk of developing secondary infections that may increase length of stay and possibly even morbidity. This fragile patient population requires special attention and meticulous adherence to established nursing standards of care. These standards of care are founded on evidenced based practices. It is important that nurses receive education about why these standards are in place and what consequences can result due to not following the established care protocols.

Critically ill patients who are intubated on mechanical ventilation for more than 24 hours of are at an increased risk of 6 to 21 times of developing ventilator associated pneumonia (VAP). Patients intubated for lesser than 24 hours are at 3 times the risk of acquiring VAP.15

Nardi (2012) has found the following: Ventilator-Associated Pneumonia (VAP) is the second most common Healthcare-Associated Infection (HAI) in the United States and is responsible for 25% of the infections that occur in intensive care units (ICUs). VAP is associated with increases in death rates, lengths of stay, and healthcare costs. (p. 41) As frontline caregivers and advocates for their patients, nurses need to understand the basics of VAP, risk factors for this type of pneumonia, and strategies that may avoid the

The purpose of this document is a critical study and analysis of the oral care provided by nursing staff as part of the Ventilator Care Bundle (VCB) and to assess whether the frequency of mouth care performed is related to the prevention of Ventilator Associated Pneumonia (VAP) in patients mechanically ventilated (Zilberberg et al. 2009).

To encourage physicians, ICU nurses, and respiratory therapist to use the ventilator associated pneumonia bundle in all ventilated patients in an intensive care unit.

Even though the consequence of saline instillation on a ventilator patient in the acute care setting is pneumonia or the patient may become hemodynamically unstable, this practice remain contentious, the practice of this procedure will also decrease the oxygenation. (Ayhan, et al., 2015),

Ventilator-associated pneumonia is a bacterial infection that occurs in the lower respiratory system within the first 48 hours of endotrachal intubation (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2011). Although any hospital patient is susceptible to pneumonia, ventilator dependent patients are at the highest risk of acquiring pneumonia. The purpose of this paper is to identify the risk factors, incidences, and preventions of ventilator-associated pneumonia (VAP) using a quantitative research study performed in Malaysia. “The aim of this

The purpose of this paper is to assess the effects of oral care on ventilator-associated pneumonia for inpatient

From investigation in health practices, ventilator associated pneumonia caught my attention. “Ventilator Associated Pneumonia (VAP) is a leading cause of morbidity and mortality in intensive care units. Most episodes of VAP are thought to develop from the aspiration of oropharyngeal secretions containing potentially pathogenic organisms. Aspiration of gastric secretions may also contribute, though likely a lesser degree. Tracheal intubation interrupts the body’s anatomic and physiologic defenses against aspiration, making mechanical ventilation a major risk for Ventilator Associated Pneumonia. Semi-recumbent positioning of mechanically ventilated patients may help reduce the incidence of gastroesophageal reflux and lead to a decreased incidence of VAP. The one randomized trial to date of semi- recumbent positioning shows it to be an effective method of reducing VAP. Immobility in critically ill patients leads to atelectasis and decreased clearance of bronchopulmonary secretions. The accumulation of contaminated oropharyngeal secretions above the endotracheal tube cuff may contribute to the risk of aspiration. Removing these

Ventilator-associated pneumonia (VAP) is a hospital-acquired condition that is currently not on the Centers for Medicare and Medicaid Services’ (CMS) list of non-payment hospital-acquired infections (CMS, 2015). However, the thought of adding VAP to the list occurred in past discussions by CMS (CMS, 2008). This may change when there is an improved definition with clearer inclusion criteria that is currently being constructed by the CDC (Klompas et al., 2014). Nonetheless, the goal is to prevent hospital-acquired illnesses like VAP. After performing a review of care interventions for the prevention of VAP, a collaborative team between the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in

Ventilator-associated pneumonia compounds the risks that critically-ill patients face in hospitalization. It affects a high proportion of patients on ventilators and has a fluctuating morbidity rate. The goal of this paper is to demonstrate the potential usefulness of chlorhexidine in preventing ventilator-associated pneumonia in adults. The paper features a review of literature found via MedScape using the keywords “chlorhexidine,” “ventilator-associated pneumonia,” “long-term ventilation” and “prevention.” The results show that there is a positive correlation between using chlorhexidine in the oral care of patients using a ventilator; however, the evidence thus far does not present an opportunity to promote any clinical recommendations.

Based oral care protocol to decrease ventilator-associate pneumonia. Dimensions of Critical Care Nursing 31(5), 301-308. doi: 10.1097/DCC.0b013e3182619b6f

To effectively investigate the question, research was established using CINAHL as the main database of research. Cochrane was yielded for research results, but CINAHL yielded more results than Cochrane. Yet still, even with this, the results found on CINAHL showed no articles that compared CoughAssist and regular suction, in relation with amount of patient suctioning. As such, other articles with similar research angles were utilized to answer the question. This resulted in five articles which help one to make an inference on how CoughAssist may help reduce amount of suction needed by a patient.

Oronasal mask was used with all subjects to start NIV. Manually and/or Mechanically Assisted Cough - manually assisted cough was employed to provide optimal insufflations. Portable ventilator was used to deliver deep insufflations. Both assisted coughs were administered for the first 3 days of the home care practical by a respiratory care therapist, who visited the patients every morning. They trained them for 3 days how to use NIV. The pulmonology also visited the subjects for the first three days. The nurses visited the patients mornings and afternoons until recover them not to getting worst.

“Ventilator -associated pneumonias are the leading cause of death for patients diagnosed with hospital acquired infections” (Sadeghi, Barzi, Mikhail, & Shabot, 2013, p. 223). Pneumonia rates are higher in mechanically ventilated patients because the artificial airway increases the opportunity for aspiration and colonization. The rate of VAP increases for patients ventilated more than three days resulting in length of stay in ICU and LOS after discharge from ICU (Sedwick, Lance-0Smith, Reeder, & Nardi, 2012).