Revisione della letteratura: il ruolo dell’infermiere nella prevenzione delle infezioni polmonari nella persona assistita ventilata meccanicamente

Ventilator-associated pneumonia (VAP) is the most common infectious disease in patients requiring mechanical ventilation in the intensive care unit (ICU). VAP occurs when a patient who does not present symptoms of pneumonia or an infection during the incubation period develops the disease after at least 48 hours of mechanical ventilation and intubation, up to 48 hours after removal (Tablan et al., 2003). New or progressive infiltrates, systemic infection (such as fever or changes in white blood cell count), changes in sputum characteristics, and the detection of a causative agent are observed in patients with VAP. VAP is the most common ICU-acquired pneumonia among patients invasively intubated for mechanical ventilation. Patients affected by this respiratory condition have an attributable mortality rate of 13.5%. This leads to an increased length of hospital stay and a greater financial burden. Although delayed administration of antimicrobial drugs has been associated with higher mortality, early diagnosis of VAP is essential. Once a patient develops VAP, they remain in intensive care for an additional 4-9 days, with a mortality rate twice as high as non-VAP patients. It is estimated that VAP causes approximately 36,000 deaths annually in the United States. In Europe, there are about 18,900 confirmed cases of VAP each year, with reported mortality rates of 50-76% in severe cases (Álvarez-Lerma et al., 2018). A study conducted in Korea demonstrated that approximately 52.6% of all pneumonia patients had VAP, with a mortality rate ranging from 24% to 50%. Of these patients, 70% were classified as high-risk; therefore, many ICU patients undergoing mechanical ventilation develop VAP, leading to prolonged hospitalization, increased medical expenses, and a higher risk of mortality. Due to its impact on patients, families, and society, VAP is a medical issue that must be prevented (Kim et al., 2020). To prevent VAP, the "bundle approach" has emerged, referring to a set of preventive interventions. The Institute of Healthcare Improvement (IHI) in the United States introduced a VAP prevention bundle that includes four elements: head-of-bed elevation, peptic ulcer disease (PUD) prophylaxis, deep vein thrombosis (DVT) prophylaxis, and daily sedation interruption with an assessment of extubation readiness. European countries have also introduced guidelines for clinical practice, consisting of five categories that prioritize and emphasize the importance of VAP prevention interventions: non-ventilatory circuit modifications unless specifically indicated, alcohol-based hand hygiene, properly trained and educated staff, incorporation of sedation control and weaning protocols in patient care, and oral hygiene with chlorhexidine (Rello et al., 2010). Notably, the Korea Disease Control and Prevention Agency (KDCA) has also introduced a VAP prevention bundle consisting of five categories based on national medical institution assessment standards aligned with the Centers for Disease Control and Prevention (CDC) guidelines: head-of-bed elevation, daily sedation interruption and extubation readiness assessment, peptic ulcer disease (PUD) prophylaxis, deep vein thrombosis (DVT) prophylaxis, and daily oral care with chlorhexidine (CDC, 2017). Research on VAP prevention has followed, demonstrating the preventive effects of various interventions through studies on VAP prevalence.

La polmonite associata alla ventilazione (VAP) è la malattia infettiva più comune nei pazienti che necessitano di ventilazione meccanica in terapia intensiva (ICU). La VAP si verifica quando un paziente che non presenta sintomi di polmonite oppure un'infezione durante il periodo di incubazione, sviluppa la malattia da almeno 48 ore di ventilazione meccanica e intubazione, fino ad altre 48 ore dopo la rimozione (Tablan, et al., 2003). Infiltrati di natura nuova o progressiva, infezione sistemica, come febbre o alterazione della conta dei globuli bianchi, cambiamenti nelle caratteristiche dell'espettorato ed il rilevamento di un agente causale sono osservati nei pazienti con VAP. La VAP è la polmonite acquisita in terapia intensiva più comune tra i pazienti intubati in modo invasivo per ventilazione meccanica. I pazienti affetti da tale patologia respiratoria, hanno una mortalità attribuibile del 13,5%. Ciò comporta un aumento della durata della degenza in ospedale ed un aumento dell'onere finanziario.