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Prevention of ventilator-associated pneumonia through care bundles:A systematic review and meta-analysis

Journal of Intensive Medicine 2023年第4期3卷 352-364页

作者： Raquel Martinez-Reviejo Sofia Tejada Miia Jansson alfonsina ruiz-spinelli Sergio Ramirez-Estrada Duygu Ege Tarsila Vieceli Bert Maertens Stijn Blot Jordi Rello Centro de Investigación Biomédica en Red de Enfermedades Respiratorias(CIBERES) Instituto de Salud Carlos IIIMadrid 28029Spain Clinical Research Epidemiology in Pneumonia&Sepsis(CRIPS) Vall d'Hebron Institute of Research(VHIR)Barcelona 08035Spain Research Unit of Health Sciences and Technology University of OuluOulu90570Finland RMIT University Melbourne3010Australia Critical Care Department Hospital de Clínicas Dr.Manuel QuintelaMontevideo11600Uruguay Critical Care Department Clínica CorachanBarcelona08017Spain Emergency Medicine Department Adnan Menderes UniversityAydin09010Turkey Infectious Diseases Department Hospital de Clínicas de Porto AlegrePorto Alegre90035-903Brazil Department of Internal Medicine and Pediatrics Ghent UniversityGhent9000Belgium FOREVA Clinical Research CHU NimesUniversitéde Nîmes-MontpellierNîmes30012France Medicine Department Universitat Internacional de Catalunya(UIC)Barcelona08017Spain

Background Ventilator-associated pneumonia(VAP)represents a common hospital-acquired infection among mechanically ventilated *** summarized evidence concerning ventilator care bundles to prevent *** A systematic review and meta-analysis were *** controlled trials and controlled observational studies of adults undergoing mechanical ventilation(MV)for at least 48 h were considered for *** of interest were the number of VAP episodes,duration of MV,hospital and intensive care unit(ICU)length of stay,and mortality.A systematic search was conducted in the MEDLINE,the Cochrane Library,and the Web of Science between 1985 and *** are reported as odds ratio(OR)or mean difference(MD)with 95%confidence intervals(CI).The PROSPERO registration number is *** Thirty-six studies including 116,873 MV participants met the inclusion criteria.A total of 84,031 participants underwent care bundles for VAP *** most reported component of the ventilator bundle was head-of-bed elevation(n=83,146),followed by oral care(n=80,787).A reduction in the number of VAP episodes was observed among those receiving ventilator care bundles,compared with the non-care bundle group(OR=0.42,95%CI:0.33,0.54).Additionally,the implementation of care bundles decreased the duration of MV(MD=−0.59,95%CI:−1.03,−0.15)and hospital length of stay(MD=−1.24,95%CI:−2.30,−0.18)in studies where educational activities were part of the *** regarding mortality were *** The implementation of ventilator care bundles reduced the number of VAP episodes and the duration of MV in adult *** application in combination with educational activities seemed to improve clinical outcomes.

关键词： Hospital-acquired pneumonia Ventilator bundle Prevention Quality improvement intervention

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Does COVID-19 increase the risk of neuropsychiatric sequelae? Evidence from a mendelian randomization approach

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World Journal of Psychiatry 2022年第3期12卷 536-540页

作者： alfonsina Tirozzi Federica Santonastaso Giovanni de Gaetano Licia Iacoviello Alessandro Gialluisi Department of Epidemiology and Prevention IRCCS Istituto Neurologico Mediterraneo NeuromedPozzilli 86077Italy Department of Medicine and Surgery University of InsubriaVarese 21100Italy

Observational studies based on electronic health records (EHR) report anincreased risk of neurological/neuropsychiatric sequelae for patients who havehad coronavirus disease 2019 (COVID-19). However, these studies may sufferfrom biases such as unmeasured confounding, residual reverse causality, or lackof precision in EHR-based diagnoses. To rule out these biases, we tested causallinks between COVID-19 and different potential neurological/neuropsychiatricsequelae through a two-sample Mendelian randomization analysis of summarystatistics from large Genome-Wide Association Scans of susceptibility to COVID-19 and different neurological and neuropsychiatric disorders, including majordepression, anxiety, schizophrenia, stroke, Parkinson’s and Alzheimer’s *** found robust evidence suggesting that COVID-19 – notably the hospitalizedand most severe forms – carries an increased risk of neuropsychiatric sequelae,particularly Alzheimer’s disease, and to a lesser extent anxiety disorder. In linewith a large longitudinal EHR-based study, this evidence was stronger for moresevere COVID-19 forms. These results call for a targeted screening strategy totackle the post-COVID neuropsychiatric pandemic.

关键词： COVID-19 Sars-CoV-2 Neurological disorders Neuropsychiatric disorders Alzheimer’s disease Anxiety Mendelian randomization

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