Università degli studi di Modena e Reggio Emilia

Università degli Studi di Modena e Reggio Emilia
Corso di laurea in infermieristica - Sede di Modena

Abstract

My dissertation analyses a complication that often arises in intensive care: VAP (Ventilator Associated Pneumonia), which causes an increase in death rate (46%), in hospital days needed (from 4 up to 19) and in company costs. It is possible to outline two different types of pneumonia: early VAP, that appears within 48-72 hours after intubation, and late VAP, that arises within 72-96 hours after intubation. The real cause, of this pathology, is not ventilation but endotracheal intubation, which induces a pathogens movement from the environment, health workers, oral cavity or superior airways to lower airways, causing a patient infection. Intensive care patients who have contract VAP will show two or more symptoms such as an over 38°C fever, an elevated or low white blood cells level, a purulent sputum, a cough, a dyspnoea and breathing difficulties. Despite the uncertainty of the diagnosis, it is possible to collect enough data in order to develop an appropriate antibiotic therapy necessary for healing through blood culture, examinations, algorithms (NNIS and CPIS) and culturing bronchial samples (TA, PSB and BAL). A further significant aspect of this dissertation regards nursing skills, which are essential in order to obtain a faster VAP healing and prevention. The nurse has to clean hands frequently, wear safe measures, give the patient a good oral hygiene, endotracheal and subglottic suctions, change the patient position, wean early ventilator, employ SNG, use the humidifier, change the ventilator circuit, prevent biofilm on endotracheal tube or tracheostomic pipe. All these preventive strategies would lead to a patient improvement, with a consequent lower incidence and death rate. Nurse’s aim is to know and apply these techniques in order to guarantee an excellent patient aid and a  faster discharge.