Keywords
dispositivo médico
infecciones
cuidados críticos
neumonía asociada al ventilador Mechanical ventilation
medical device
infections
critical care
ventilator-associated pneumonia
How to Cite
Abstract
Introduction: Ventilator-associated pneumonia (VAP) is a frequent and potentially fatal complication in patients requiring invasive ventilatory support. To prevent VAP, raising the head of the bed above 30° has been evaluated. The objective of this study was to design and implement an inclinometer device in an intensive care unit (ICU) in Bogota to increase adherence to raising the head of the bed above 30°.
Methods: After designing the device that measures the head of the bed's inclination (inclinometer), inclinometer devices were installed on three ICU beds, and the inclination was recorded in three patients.
Results: The inclinometer has an Arduino device with an integrated circuit installed at the head of the bed, sensing its inclination with light and sound indicators depending on the degree of inclination greater or less than 30°. The ICU staff was trained in calibrating and interpreting the indicators. Subsequently, the inclinometer was used on three beds, following three patients during the period of invasive mechanical ventilation, with a total of 9,237 records with an average inclination of 34.4°, remaining 92.2% of the time with an inclination greater than 30°. None of the patients developed VAP.
Conclusions: The inclinometer device has a simple box design with light and sound signals. Its use obtained an inclination of the head of the bed greater than 30° in more than 90% of the duration of mechanical ventilation.
References
Papazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med. 2020 May;46(5):888-906. https://doi.org/10.1007/s00134-020-05980-0
Ferrer M, Torres A. Epidemiology of ICU-acquired pneumonia. Curr Opin Crit Care. 2018 Oct;24(5):325-331. https://doi.org/10.1097/MCC.0000000000000536
Coppadoro A, Bellani G, Foti G. Non-Pharmacological Interventions to Prevent Ventilator-Associated Pneumonia: A Literature Review. Respir Care. 2019 Dec;64(12):1586-1595. https://doi.org/10.4187/respcare.07127
Niedzwiecka T, Patton D, Walsh S, Moore Z, O'Connor T, Nugent L. What are the effects of care bundles on the incidence of ventilator-associated pneumonia in paediatric and neonatal intensive care units? A systematic review. J Spec Pediatr Nurs. 2019 Oct;24(4):e12264. https://doi.org/10.1111/jspn.12264
Pozuelo-Carrascosa DP, Cobo-Cuenca AI, Carmona-Torres JM, Laredo-Aguilera JA, Santacruz-Salas E, Fernandez-Rodriguez R. Body position for preventing ventilator-associated pneumonia for critically ill patients: a systematic review and network meta-analysis. J Intensive Care. 2022 Feb 22;10(1):9. https://doi.org/10.1186/s40560-022-00600-z
Hamishehkar H, Vahidinezhad M, Mashayekhi SO, Asgharian P, Hassankhani H, Mahmoodpoor A. Education alone is not enough in ventilator associated pneumonia care bundle compliance. J Res Pharm Pract. 2014 Apr;3(2):51-5. https://doi.org/10.4103/2279-042X.137070
Llaurado-Serra M, Ulldemolins M, Güell-Baró R, Coloma-Gómez B, Alabart-Lorenzo X, López-Gil A, Bodí M, Rodriguez A, Jiménez-Herrera MF; CAPCRI Study Investigators. Evaluation of head-of-bed elevation compliance in critically ill patients under mechanical ventilation in a polyvalent intensive care unit. Med Intensiva. 2015 Aug-Sep;39(6):329-36. https://doi.org/10.1016/j.medin.2014.07.009
Balonov K, Miller AD, Lisbon A, Kaynar AM. A novel method of continuous measurement of head of bed elevation in ventilated patients. Intensive Care Med. 2007 Jun;33(6):1050-4. https://doi.org/10.1007/s00134-007-0616-0
Williams Z, Chan R, Kelly E. A simple device to increase rates of compliance in maintaining 30-degree head-of-bed elevation in ventilated patients. Crit Care Med. 2008 Apr;36(4):1155-7. https://doi.org/10.1097/CCM.0b013e318168fa59
Wolken RF, Woodruff RJ, Smith J, Albert RK, Douglas IS. Observational study of head of bed elevation adherence using a continuous monitoring system in a medical intensive care unit. Respir Care. 2012 Apr;57(4):537-43. https://doi.org/10.4187/respcare.01453
International Committee of Medical Journal Editors. Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals. ICMJE | News & Editorials. 2022 May.
Torres A, Niederman MS, Chastre J, Ewig S, Fernandez-Vandellos P, Hanberger H, Kollef M, Li Bassi G, Luna CM, Martin-Loeches I, Paiva JA, Read RC, Rigau D, Timsit JF, Welte T, Wunderink R. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT). Eur Respir J. 2017 Sep 10;50(3):1700582. https://doi.org/10.1183/13993003.00582-2017
Muscedere J, Rewa O, McKechnie K, Jiang X, Laporta D, Heyland DK. Subglottic secretion drainage for the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis. Crit Care Med. 2011 Aug;39(8):1985-91. https://doi.org/10.1097/CCM.0b013e318218a4d9
Fitch ZW, Duquaine D, Ohkuma R, Schneider EB, Whitman GJ. Hospital Bed Type, the Electronic Medical Record, and Safe Bed Elevation in the Intensive Care Setting. Am J Med Qual. 2016 Jan-Feb;31(1):69-72. https://doi.org/10.1177/1062860614556743
Niedzwiecka T, Patton D, Walsh S, Moore Z, O'Connor T, Nugent L. What are the effects of care bundles on the incidence of ventilator-associated pneumonia in paediatric and neonatal intensive care units? A systematic review. J Spec Pediatr Nurs. 2019 Oct;24(4):e12264. https://doi.org/10.1111/jspn.12264
Hiner C, Kasuya T, Cottingham C, Whitney J. Clinicians' perception of head-of-bed elevation. Am J Crit Care. 2010 Mar;19(2):164-7. https://doi.org/10.4037/ajcc2010917
Martí-Hereu L, Arreciado Marañón A. Time of elevation of head of bed for patients receiving mechanical ventilation and its related factors. Enferm Intensiva. 2017 Oct-Dec;28(4):169-177. https://doi.org/10.1016/j.enfi.2017.02.004
del Cotillo Fuente M, Valls Matarín J. Análisis del cumplimiento de 2 medidas para prevenir la neumonía asociada a la ventilación mecánica (elevación de la cabecera y control del neumotaponamiento) [Analysis of compliance of 2 prevention measures for ventilator-associated pneumonia (raised head of bed and cuff pressure control)]. Enferm Intensiva. 2014 Oct-Dec;25(4):125-30. https://doi.org/10.1016/j.enfi.2014.03.005