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Review Article Specialized nursing intervention on critically ill patient in the prevention of intubation-associated pneumonia: an integrative literature review
Daniela Fradinho Almeida1orcid, Maria do Rosário Pinto2,3orcid, Maria Candida Durao2orcid, Helga Rafael Henriques4orcid, Joana Ferreira Teixeira2,5orcid

DOI: https://doi.org/10.4266/acc.2024.00528
Published online: July 22, 2024

1Critical Care Department of CHULC-HSJ; Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Project InfPrev4frica, Lisbon, Portugal

2Nursing School of Lisbon (ESEL) - Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Project InfPrev4frica, Lisbon, Portugal

3UICISA: E, Coimbra, Portugal

4Nursing School of Lisbon (ESEL) - Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Lisbon, Portugal

5School of Medicine and Biomedical Sciences (ICBAS) - University of Porto; CINTESIS@RISE, Porto, Portugal

Received: 17 November 2023   • Accepted: 28 June 2024
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Healthcare-associated infections are adverse events that affect people in critical condition, especially when hospitalized in an intensive care unit. The most prevalent is intubation-associated pneumonia (IAP), a nursing-care-sensitive area. This review aims to identify and analyze nursing interventions for preventing IAP. An integrative literature review was done using the Medline, CINAHL, Scopus and PubMed databases. After checking the eligibility of the studies and using Rayyan software, ten final documents were obtained for extraction and analysis. The results obtained suggest that the nursing interventions identified for the prevention of IAP are elevating the headboard to 30º; washing the teeth, mouth and mucous membranes with a toothbrush and then instilling chlorohexidine 0.12%–0.2% every 8/8 hr; monitoring the cuff pressure of the endotracheal tube (ETT) between 20–30 mm Hg; daily assessment of the need for sedation and ventilatory weaning and the use of ETT with drainage of subglottic secretions. The multimodal nursing interventions identified enable health gains to be made in preventing or reducing IAP. This area is sensitive to nursing care, positively impacting the patient, family, and organizations. Future research is suggested into the effectiveness of chlorohexidine compared to other oral hygiene products, as well as studies into the mortality rate associated with IAP, with and without ETT for subglottic aspiration.

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