Abstract
Background
Atelectasis and pneumonia are highly prevalent in patients under mechanical ventilation.
Studies indicate that using ventilation with an open lung concept improves recovery,
decreases ventilator-related pneumonia, decreases mortality and leads to faster weaning
from the ventilator. Therefore, this study investigated the effect of higher airway
pressure on ventilator-associated pneumonia.
Methods
This randomized clinical trial was conducted on 120 patients under mechanical ventilation.
The patients were divided into two groups based on ventilator pressure: the control
group (pressure level 20) and the intervention group (pressure level 30). Demographic
data, disease severity, the incidence of ventilator-associated pneumonia, organ damage,
days connected to the ventilator, length of hospitalization in ICU, and mortality
were compared between the two groups.
Results
There was no significant difference in demographic data and disease severity between
the two groups. The average Clinical Pulmonary Infection Score in the intervention
group was significantly lower than the control group (P = 0.02). The intervention group's average Sequential Organ Failure Assessment score
was significantly lower than the control group (p = 0.016).
Conclusions
High-pressure levels can decrease ventilator-associated pneumonia and organ failure.
It is recommended that the study be repeated with a larger, more diverse population.
Key Indexing Terms
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of the Medical SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Hospital infection prevention: how much can we prevent and how hard should we try?.Curr Infect Dis Rep. 2019; 21: 2
- Nosocomial infection.Crit Care Med. 2021; 49: 169-187
- The incidence of ventilator-associated pneumonia (VAP) in a tertiary-care center: comparison between pre-and post-VAP prevention bundle.J Infect Public Health. 2020; 13: 552-557
- Ventilator-associated pneumonia in adults: a narrative review.Intensive Care Med. 2020; 46: 888-906
- Prevention of early ventilation- acquired pneumonia (VAP) in comatose brain-injured patients by a single dose of ceftriaxone: PROPHY-VAP study protocol, a multicentre, randomized, double-blind, placebo-controlled trial.BMJ Open. 2018; 8e021488
Papazian L., Klompas M., Luyt C.E.J.I. Ventilator-associated pneumonia in adults: a narrative review. 2020;46(5):888-906.
- Incidence, risk factors, and outcome of ventilator-associated pneumonia.J Crit Care. 2006; 21: 56-65
- Incidence, risk factors, and outcome of ventilator-associated Pneumonia in 18 hospitals of Iran. Running title: ventilator-associated pneumonia in Iran.J Adv Biotechnol Res. 2016; 7: 936-946
- Epidemiology and outcomes of ventilator-associated pneumonia in a large US database.Chest. 2002; 122: 2115-2121
- Epidemiology and outcomes of ventilator-associated pneumonia in northern Brazil: an analytical descriptive prospective cohort study.BMC Infect Dis. 2013; 13: 1-6
- Estimating the attributable mortality of ventilator-associated pneumonia from randomized prevention studies.CRIT CARE MED. 2011; 39: 2736-2742
- A systematic scoping review of the cost-impact of ventilator-associated pneumonia (VAP) intervention bundles in intensive care.Am J Infect Control. 2021; 49 (Jul): 928-936
- Acute lobar atelectasis.Chest. 2019; 155: 1049-1058
- Effects of positive end-expiratory pressure/recruitment maneuvers compared with zero end-expiratory pressure on atelectasis during open gynecological surgery as assessed by ultrasonography: a randomized controlled trial.Br J Anaesth. 2020; 124: 101-109
- Identification of factors affecting mortality in late-onset ventilator-associated pneumonia.Eurasian J Med. 2020; 52: 254
- Indices of acceleration atelectasis and the effect of hypergravity duration on its development.Exp Physiol. 2021; 106: 18-27
- Incidence and risk factors of pulmonary atelectasis in mechanically ventilated trauma patients in ICU: a prospective study.Int J Evid Based Healthc. 2019; 17: 44-52
- Re-expansion of atelectasis during general anesthesia: a computed tomography study.BJA Br J Anaesth. 1993; 71: 788-795
- Increased inspiratory pressure for reduction of atelectasis in children anesthetized for CT scan.Pediatr Radiol. 2002; 32: 344-347
- Acute physiology and chronic health evaluation II score as a predictor of hospital mortality in patients of coronavirus disease 2019.Crit Care Med. 2020; 48: e657
- Ventilation modes for obese patients under mechanical ventilation.Mechanical Ventilation in the Critically Ill Obese Patient. Springer, 2018: 163-177
- The current epidemiological landscape of ventilator-associated pneumonia in the intensive care unit: a multicenter prospective observational study in China.Clin Infect Dis. 2018; 67: S153-SS61
- Trauma and antimicrobial resistance are independent predictors of inadequate empirical antimicrobial treatment of ventilator-associated pneumonia in critically ill patients.Surg Infect. 2021; 22: 730-737
- Microaspiration in intubated critically ill patients: diagnosis and prevention.Infect Disord Drug Targets. 2011; 11: 413-423
- Microorganisms and clinical outcomes of early-and late-onset ventilator-associated pneumonia at Srinagarind Hospital, a tertiary center in Northeastern Thailand.BMC Pulm Med. 2021; 30 (21): 47
- Driving pressure during thoracic surgery: a randomized clinical trial.Anesthesiology. 2019; 130: 385-393
- The association between higher driving pressure and higher mortality in patients with pneumonia without acute respiratory distress syndrome.J Formos Med Assoc. 2021; 120: 204-211
- Mortality prediction by SOFA score in ICU-patients after cardiac surgery; comparison with traditional prognostic– models.BMC Anesthesiol. 2020; 20: 1-8
- Validation of prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among cardiac-, thoracic-, and vascular- surgery patients admitted to a cardiothoracic intensive care unit.J Card Surg. 2020; 35 (118-2)
- Driving pressure and hospital mortality in patients without ARDS: a cohort study.Chest. 2018; 153: 46-54
Article info
Publication history
Published online: October 02, 2022
Accepted:
July 14,
2022
Received:
October 25,
2021
Identification
Copyright
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
