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Review of Literature Ventilator Associated Pneumonia

Ventilator-associated pneumonia: comparison between quantitative and qualitative cultures of tracheal aspirates

This work investigated the significance of quantitative results in regards to tracheal secretion. Quantitative cultures exhibited increased specificity over qualitative cultures but posted a decreased sensitivity compared to qualitative. VAP diagnosis prediction was not achievable through quantification It involved 106 ICU patients under ventilation support. Evaluation of both clinical and radiological values and a conclusive diagnosis emanated from an agreement of the two or all experts. There is no consistency in endotracheal aspirate hence; it cannot evaluate the quantification of microorganisms in tracheal aspirates. Quantitative cultures from aspirated tracheal samples had increased specificity and decreased sensitivity as opposed to those from qualitative cultures. Management of VAP by Nurses depends on qualitative findings instead of quantitative cultures; the latter have high costs and workload as opposed to qualitative.

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Diagnosis of ventilator-associated pneumonia: a Systematic Review of the literature

The study involved a qualitative review of published materials to compare criteria of diagnosing VAP especially on its importance in diagnosing, culturing methods, and effects to the host. The study involved a Medline search of published literature on VAP and diagnostic availability. There was analysis of 64 articles and 25 adult patients who contributed to the study.

Quantitative cultures obtained by criteria including BAL, pBAL, and TBA seem to be equal in diagnosing VAP. Before nurses can decide on antibiotic therapy, they ought to evaluate their patients by imaging process, culturing bacteria, and utilizing biomarkers to make a sound decision. This would not only reduce mortality rate but also cut on medical cost to the patients.

Impact of Invasive and Noninvasive Quantitative Culture Sampling on Outcome of Ventilator-Associated Pneumonia

The study evaluated the impact of using both invasive (PSB and BAL) fiber optic bronchoscopy and noninvasive quantitative endotracheal aspirates QEA diagnostic methods for VAP. Diagnosis on first group was based on QEA and fiber optic bronchoscopy in association with PSB and BAL, while the second group were sampled using QEA only. The study was limited to a smaller sample size, hence unreliable. Though it offers good diagnostic tidbits, a fiber optic bronchoscopy using PSB or BAL is expensive and time consuming. Both invasive and noninvasive diagnostic criteria had no differences in mortality or morbidity rate. The significance to nurse occurs when choosing the type of antibiotic to administer since the prognostic factor for poor recovery from pneumonia is treatment with inappropriate antibiotics. There is a reduction in mortality and costs when the right regimen is given.

Quantitative Culture of Endotracheal Aspirates in the Diagnosis of Ventilator-Associated Pneumonia in Patients with Treatment Failure

The study investigated the correlation between noninvasive quantitative endotracheal aspirate cultures with both protected specimen brush (PSB) and BAL to VAP patients with medical complications. The correlations between QEA /PSB and QEA/ BAL were very significant. They are all within an acceptable specificity and sensitivity. There was the recruitment of Forty-eight patients under mechanical ventilation and suspicious of VAP. QEA cultures choice as diagnostic tool leads to overtreatment while the combination of PSB and BAL as reference increase the specificity of QEA in VAP diagnosis. The limitation of the study was the small sample size. The combination of both PSB and BAL increased the agreement between invasive and non-invasive methods to 92%. Prior use of QEA could be more significant to nurses in arranging for appropriate antibiotic use. It saves costs and reduces the risks of antibiotic misuse.

The Role of Quantitative Cultures of Non-Bronchoscopic Samples in Ventilator-Associated Pneumonia’

The study determined the importance of quantitative cultures of non-Bronchoscopic samples and Endotracheal aspirates for the management of VAP. The study involved fifteen patients in ICU undergoing mechanical ventilation for a period not less than 48 hours. There were two groups of patients. Comparison of results to gold-standard methods like lung tissue histology is a requirement. The sample size used also raises an eyebrow; a similar study on a larger group could validate it.

BBS and ETA methods were in harmony. The importance of the findings in nursing is that the quantitative culture obtained from lower respiratory tract samples through non-Bronchoscopic method facilitates management and early diagnosis of VAP. This method is safe to their patients as well as being cost effective.

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Efficacy of Bilateral Bronchoalveolar Lavage for Diagnosis of Ventilator-Associated Pneumonia

The study focused on getting already published materials that evaluated the accuracy of BAL methods using fiber optic bronchoscopy to diagnose VAP. A prospective study on 23 articles had a review and enrollment of 957 patients suspected of VAP. There was no standardized method for calculating both specificity and sensitivity; some studies did not report either. BAL has two major risks, those associated with the use of fiber optic bronchoscope, and those gotten when instilling fluid during bronchoscopy. With a variety of literature at their disposal prior done on management of VAP, clinician or nurse could settle to a particular study diagnostic criterion that is less expensive to the patient as far as the cost of the procedure and antibiotic therapy is concerned.

Efficacy of Bilateral Bronchoalveolar Lavage for Diagnosis of Ventilator-Associated Pneumonia

The study investigated the effectiveness of BAL in detecting the bacterial cause of VAP that existed for a period over 5 years to a total of 27 mechanically ventilated patients who provided 399 BAL samples for quantitative bacterial cultures there was a comparison of cultures and radiographic findings

The right lung sample offered better predictor of VAP presence than bilateral. The major strength of this work was the large number of patients sampled, most of whom were trauma males’ patients the study did not compare their results with a gold standard analysis like histological processing to help in confirming infection. Nurses can consider carrying out unilateral right lung samples instead of bilateral sampling when detecting causative agents for VAP make their work faster and safer for the patients.

The Appropriate Diagnostic Threshold for Ventilator Associated Pneumonia Using Quantitative Cultures

The study reflected on analysis of a larger patient population for purpose of deciding the maximum effects of VAP, as well as identifying the potential patient size who may benefit from a lower threshold. The work came up an idea that the occurrence frequency of organisms in false negative results was similar to those seen in VAP but did not give false negative BAL.

526 patients underwent fiber optic bronchoscopy procedures with BAL and culturing happened later for microbiological assay. Data included cultured organisms, quantitative colony counts, duration of culturing, and the sensitivities of the methods. This study is important to nurses in early identifying a patient likely to develop false-negative test results. The early false negative BALs result is vital for appropriate therapy institutions and hence reduces mortality that is usually associated with delay in diagnosis.

Direct E-test (AB Biodisk) of respiratory samples improves antimicrobial use in ventilator-associated pneumonia

A European Task Force composed of experts in the field of ventilator-associated pneumonia steered by Torres and J. Carlet answered some questions regarding VAP management. It came up with the idea that the only alternative to diagnosing VAP is through the Clinical Pulmonary Infection Score (CPIS).

Mortality and the Diagnosis of Ventilator-associated Pneumonia: A New Direction

This article reviewed studies done by other researcher. It reviewed publications dealing with description, contrast, and debates on the merits of some techniques and strategies for diagnosis of VAP. However, most of previous studies did not address the inaccuracies of clinical criteria for diagnosing VAP as this paper did.

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The methodology used in this article was mainly literature review of secondary data. The limitation in this work was the absence of raw data to support the facts discussed by the researcher. However, much information criticized the deficits in other researcher.

Nurses and physicians are likely to benefit from the truth revealed in this article in deciding whether to use quantitative or no quantitative cultures for better outcomes.

Bronchoscopic BAL in the Diagnosis of Ventilator Associated Pneumonia

This article covered utilization of fiber optic bronchoscopy in BAL methods. This happened by reviewing 23 studies and evaluating the efficiency of BAL methods utilizing fiber optics bronchoscopy in VAP diagnosis happened to 957 patients. The study compared BAL in either Bronchoscopic procedures or non-Bronchoscopic methods. Unfortunately, Proper standardization of BAL is yet accomplished. This method has many shortcomings in many ways such as lack of clarity on sensitivity and specifity, undefined population of study among others. The outcomes of the study revealed that the sensitivity percentage in quantitative BAL fluid was lower than specificity was higher and the results were unreliable. Nurses become aware of BAL’s major side effects since through oxygenation of VAP patients do not guarantee full recovery.

Adherence to Ventilator-Associated Pneumonia Bundle and Incidence of Ventilator-Associated Pneumonia in the Surgical Intensive Care Unit

The study examined the benefits of a ventilator-associated pneumonia bundle in VAP incidences occurring in Surgical Intensive Care Units. The rising priorities of VAP in all United SStatesICUs must have triggered this study. In addition, it reflects the increasing cases of infections of VAP in ICUs that have raised costs of medication. Due to the urgency and impacts of this situation, most hospitals and Healthcares have tried to comply with VAP prevention measures in order to curb nosocomial infection.

The researcher retrieved data from Infection Control Committee Surveillance database of SICU patients for 38 months. The availability of public database eased study. The longevity of the study ensured the efficiency of the results and conclusions. The two SICUs registered an increase of VAP bundles compliance. In addition, both nurses and patients are likely to benefit from the compliance of VAP bundles through efficiency and cost saving.

Ventilator associated pneumonia and infection control

This study reflected on causal agents of VAP as well as possible control measures of VAP. They emphasized on the risks of environment provided by pharynx and gastrointestinal tract for microorganism that that cause VAP during mechanical ventilation. They also advocate for proper control policies since diagnosis of these cases is difficult. Through literature review of previous studies, Alp and Voss defined measures that were applicable in mitigating VAP at early stages in order to save on costs of treatment. The strength of this study is the fact that related studies confirmed that cases of VAP were increasing in ICUs hence, control measures were vital. The outcomes of the study will reduce cases of infection through risks reduction, improved hospitalization environments, good hygiene among others.

Ventilator-Associated Pneumonia’ Medscape reference

This article reflects on various types of nosocomial pneumonias. The different types described include ventilator-associated and hospital –acquired pneumonia. The comparison between VAP and HAP is the means of infection and time taken to contact the disease. VAP emanates from microorganism’s inhibition in lower respiratory tract and lung parenchyma. HAP expresses some signs and symptoms 48 hours after the patient’s admission in hospital. The danger associated with HAP is the possibility of a patient being retained an extra of 7-9 day hence increasing hospital bills. The article also suggests some means of taking care of a HAP and VAP patients. In terms of methods and design, the paper had deficit in ideas. However, the article gives some advice to nurses on attending affected patients.

Clinical diagnosis of ventilator-associated pneumonia revisited: comparative validation using immediate post-mortem lung biopsies

The article had much focus on assessment of diagnostic value using various clinical criteria as well as evaluating the contributions of microbial testing ineffective clinical diagnosis of suspicious VAP. The studied sample had twenty-five patients under mechanical ventilation. There was acquisition of several bilateral lungs Specimen immediately after death. Reference testing utilized the result of presence of histological pneumonia and cases of lung cultures. As a result, there was a sensitivity of 69% and specifity of 75% due to the presence of infiltrates. The non-invasive cases also registered a certain percentage of sensitivity and specifity. The significance of this article to nurses is the revelation combination of antibiotics to the patient does not improve the effectiveness.

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References

Alp, E., & Voss, A. (2006). Ventilator associated pneumonia and infection control. Annals of Clinical Microbiology and Antimicrobials, 5(7), 1-11.

Amanullah, S. et al. (2011). Ventilator-Associated Pneumonia’ medscape reference. Web.

Bird, D. et al. (2010). Adherence to Ventilator-Associated Pneumonia Bundle and Incidence of Ventilator-Associated Pneumonia in the Surgical Intensive Care Unit. Arch Surg, 145(5), 465-470.

Bouza, E. et al. (2007). Direct E-test (AB Biodisk) of respiratory samples improves antimicrobial use in ventilator-associated pneumonia. Clin Infect Dis, 43,382-7.

Camargo, L.F.A. et al. (2004). Ventilator associated pneumonia: comparison between quantitative and qualitative cultures of tracheal aspirates. Critical Care, 8, R422- R430.

Croce, M.A. et al. (2004). The Appropriate Diagnostic Threshold for Ventilator- Associated Pneumonia Using Quantitative Cultures. J Trauma, 56, 931–936.

El-Ebiary, M., & Torres, A. (2000). Bronchoscopic BAL in the Diagnosis of Ventilator- Associated Pneumonia. Chest, 117, 198S-202S.

Fàbregas, N., et al. (1999). Clinical diagnosis of ventilator associated pneumonia revisited: comparative validation using immediate post-mortem lung biopsies. Thorax, 54(10), 867-73.

Liang, W.C. et al. (2002). Quantitative Culture of Endotracheal Aspirates in the Diagnosis of Ventilator-Associated Pneumonia in Patients with Treatment Failure. Chest, 122(2), 662-9.

Rajasekhar, et al. (2006). The Role of Quantitative Cultures of Non-Bronchoscopic Samples in Ventilator Associated Pneumonia’ Ind. J. of Med. Microb.,24, 07-113.

Rea-Neto, A. et al. (2008). Diagnosis of ventilator-associated pneumonia: a systematic Review of the literature. Critical Care, 12, 56.

Sanchez, J.M.N. et al. (1998). Impact of Invasive and Noninvasive Quantitative Culture Sampling on Outcome of Ventilator-Associated Pneumonia. Am J Respir Crit Care Med, 157, 371–376.

Wunderink, R.G. (1998). Mortality and the Diagnosis of Ventilator-associated Pneumonia: A New Direction. Am. J. Respir. Crit. Care Med., 157(2), 349-350.

Zaccard, et al. (2000). Efficacy of Bilateral Bronchoalveolar Lavage for Diagnosis of Ventilator-Associated Pneumonia. J. Clin. Microbiol., 47(9), 2918-24.

Zaccard, C.R. et al. (2009). Efficacy of Bilateral Bronchoalveolar Lavage for Diagnosis of Ventilator-Associated Pneumonia. J Clin Micr , 47(9), 2918-24.

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