Implementation of Strategy for Preventing Pneumonia Connected with Machine Ventilation

CILJ RADA: Prikazati ulogu medicinske sestre u primjeni SNOP postupaka u prevenciji VAP-a UVOD: Bolničke pneumonije povezane sa strojnom ventilacijom su vrlo česte i značajne bolničke stečene infekcije u Jedinicama intenzivnog liječenja (JIL) (1). Ventilator-associated pneumonia (VAP) engleski je (i opće prihvaćen) naziv za upalu pluća u intubiranih, strojno ventiliranih bolesnika, koja se pojavila nakon više od 48 sati strojne ventilacije ili koja je nastupila unutar 48 sati nakon što je prekinuta umjetna ventilacija (1). RASPRAVA: Rizik od razvoja VAP-a procjenjuje se na 3% na dan tijekom prvih 5 dana mehaničke ventilacije, 2% na dan od 6. do 10. dana i 1% po danu za svaki dan nakon 10. dana mehaničke ventilacije. Implementacija propisanih snopova skrbi utemeljenih na dokazima rezultira boljim ishodima liječenja te je važan multidisciplinaran pristup liječnika i medicinskih sestara u primjeni snopova skrbi, kao jedne od strategija za prevenciju pneumonija povezanih sa strojnom ventilacijom. ZAKLJUČAK: Iznimno je važno da djelatnici JIL-a u svakodnevnom radu implementiraju snopove skrbi za prevenciju VAP-a. Propisani snop postupaka za prevenciju VAP-a uključuje 1) podizanje uzglavlja postelje na 30° do 45°, 2) svakodnevni prekid sedacije i ocjenu spremnosti za ekstubaciju, 3) profilaksu želučanog ulkusa, 4) profilaksu duboke venske tromboze i 5) njegu usne šupljine preparatima klorheksidina (2).OBJECTIVE: is to show the role of nurses in the implementation of SNOP procedures in VAP prevention. INTRODUCTION: Nosocomial pneumonias associated with mechanical ventilation are very common and significant nosocomial acquired infections in Intensive Care Units (ICUs) (1). Ventilator-associated pneumonia (VAP) is an English (and generally accepted) term for pneumonia in intubated, machine-ventilated patients, which occurred after more than 48 hours of mechanical ventilation or which occurred within 48 hours after artificial ventilation was discontinued (1). DISCUSSION: The risk of developing VAP is estimated at 3% per day during the first 5 days of mechanical ventilation, 2% per day from 6th until 10th day and 1% per day for each day after 10th day of mechanical ventilation. The implementation of prescribed evidence-based bundles of care results in better treatment outcomes and is an important multidisciplinary approach by doctors and nurses in the use of bundles of care, as one of the strategies for the prevention of VAP pneumonia. CONCLUSION: It is extremely important that ICU employees implement bundles of care for VAP prevention in their daily work. Prescribed beam of procedures for the prevention of VAP includes: 1) lifting the headboard of the bed to 30° to 45°, 2) daily interruption of sedation and evaluation of readiness for extubation, 3) prophylaxis of gastric ulcer, 4) prophylaxis of deep vein thrombosis and 5) oral cavity care with chlorhexidine pre-existing products (2)