Effect of abdominal massage in preventing ventilator‐associated pneumonia in patients connected to mechanical ventilators: A systematic review
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Eser Adı dc.title |
Effect of abdominal massage in preventing ventilator‐associated pneumonia in patients connected to mechanical ventilators: A systematic review |
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Yazarlar dc.contributor.author |
Doğru, Birgül Vural |
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Yazarlar dc.contributor.author |
Serin, Emine Kaplan |
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Kurum Dışı Yazarlar dc.contributor.other |
HATİCE ŞİMŞEK |
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Yayıncı dc.publisher |
John Wiley & Sons Ltd |
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Yayın Türü dc.type |
Makale |
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Özet dc.description.abstract |
Background Ventilator-associated pneumonia (VAP) is one of the common complications in patients in the intensive care unit. Abdominal massage may prevent the development of VAP by reducing residual gastric volume in enterally fed patients. Aim The purpose of this study is to review the literature on randomized controlled and quasi-experimental studies evaluating the effectiveness of abdominal massage in preventing VAP. Methods The PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) criteria were taken as the basis for creating the protocol of the systematic review and writing the article. The systematic review was performed using the Google Scholar, PubMed, Web of Science, Scopus, CINAHL and Cochrane Library databases from December 2023 to January 2024. Studies were selected by determining inclusion and exclusion criteria according to the PICOS method. The studies were evaluated using the Joanna Briggs Institute (JBI) tool for quality assessment. Results Three randomized controlled and one quasi-experimental study with a total of 225 participants met the inclusion criteria. The four studies conducted on patients in the intensive care unit showed that abdominal massage reduced VAP. The studies reported no adverse effects of abdominal massage. Conclusion Promising evidence was found for the effect of abdominal massage in preventing VAP. However, scientific studies with larger samples, of higher quality, and using randomized controls and blinding methods are needed to evaluate the unknown dimensions of abdominal massage and determine its beneficial effects on patients. |
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Kayıt Giriş Tarihi dc.date.accessioned |
2024-12-25 |
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Yayın Yılı dc.date.issued |
2024 |
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Açık Erișim Tarihi dc.date.available |
2024-05-07 |
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Dil dc.language.iso |
eng |
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Konu Başlıkları dc.subject |
Hemşirelik |
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ISSN dc.identifier.issn |
1478-5153 |
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İlk Sayfa dc.identifier.startpage |
Mechanical ventilation aims to increase the lung compensation power of critically ill patients in intensive care with inadequate breathing, by automatically adjusting the continuation of breathing by reducing the load on the respiratory muscles.1, 2 The physiological goals of mechanical ventilation are to promote or regulate pulmonary gas exchange, increase lung volume and reduce the work of breathing. Its clinical goals are to eliminate acute respiratory failure, hypoxemia and respiratory muscle failure, provide sedation, reduce systemic or myocardial oxygen consumption and intracranial pressure and provide chest wall stabilization.1-3 In addition to all these positive features, mechanical ventilators can cause significant complications that may negatively affect the clinical course of patients.3-5 Ventilator-associated pneumonia (VAP) is one of the common complications in intensive care unit patients and is defined as pneumonia that develops 48 h after intubation in a patient on invasive mechanical ventilation support who does not have pneumonia during intubation.6 Consciousness disorders, invasive interventions to the respiratory system, medications given for stress ulcer prophylaxis, malnutrition, ventilation and perfusion imbalance, invasive gastrointestinal interventions and low intubation tube cuff pressure play a role in the development of VAP. VAP affects the mortality and morbidity rate and increases patient costs through hospitalization and ventilator stay. While the incidence of VAP in intensive care ranges from 9% to 27%, its mortality ranges from 25% to 50%.7 It is stated that the incidence of VAP in the world varies between 2.5% and 75.3%.8 The basic energy of intubated patients in intensive care units is supported through enteral and parenteral nutrition.9-11 Enteral nutrition has a complementary role because of reasons such as preserving the structural and functional integrity of the gastrointestinal mucosa, preventing the passage of bacteria from the intestines, facilitating the transition to oral nutrition by preserving intestinal motility and reducing the catabolic response to trauma.11-16 In addition to all these benefits, it also brings various complications such as an increase in the incidence of gastric residual volume (GRV), vomiting, aspiration, abdominal distention and an increase in the risk of VAP in patients on mechanical ventilation.15 These complications can worsen the patient's current condition and prolong the course of the disease. This situation may lead to increased use of medical resources and an increase in the workload of nurses, who have a key role as caregivers.10-13 For this reason, it is recommended to use pharmacological and non-pharmacological methods in the control of VAP in enterally fed patients connected to mechanical ventilation.4, 11, 14 It is stated that, in addition to the positive effects of pharmacological agents, they may cause negative effects such as abdominal cramps, allergic reactions and bronchospasm. Therefore, it is important to use simple, safe and effective methods to prevent enteral feeding intolerance. In recent years, abdominal massage (AM), a non-pharmacological method to prevent enteral feeding intolerance, has received intense attention.11-13, 16 Massage is among the nursing interventions within the scope of professional nursing practices. AM has positive effects by increasing peristaltic movement, shortening the passage of nutrients through the gastrointestinal system and the excretion process of the colon, increasing blood circulation in the region and reducing intra-abdominal pressure. Thanks to these effects, it can prevent the development of complications related to enteral nutrition. As a result of all these, preventing these complications can reduce the development of VAP by preventing the pulmonary aspirations.10-12, 17-23 Deng et al. concluded that AM-based early progressive mobilization improves gastric motility and enteral feeding tolerance in mechanically ventilated patients.24 Gafar et al. concluded that AM reduces GRV in enterally fed critical intensive care patients, AM should be a part of routine care for intensive care nurses and more studies are needed to develop this.25 When the literature is examined, various and systematic studies are seen examining the effect of AM on gastrointestinal functions in intensive care patients.10, 11, 23-25 However, no systematic review has been found evaluating the effectiveness of AM in preventing VAP in patients receiving mechanical ventilator support. In this regard, this systematic review aims to review the existing literature evaluating the effectiveness of AM in preventing VAP in patients receiving mechanical ventilator support and to systematically examine the obtained data. |
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Son Sayfa dc.identifier.endpage |
This systematic review has some limitations. The first limitation is that studies on AM that were not randomized controlled or quasi-experimental were not included. The second limitation is that the studies included in this systematic review were small studies with sample sizes of 32–70 participants, and larger studies are needed to fully examine the effect of AM on VAP. The third limitation is that only studies conducted in English were included in the review, and studies conducted in other languages were not included in the review. 6 CONCLUSION In line with these results, AM application has a significant effect in preventing VAP in enterally fed patients on mechanical ventilation. Awareness should be raised to ensure the use of this practice in intensive care units by periodically providing in-service training to intensive care nurses. It is recommended that the study findings be shared in intensive care units to ensure that AM is included in the scope of VAP prevention practices in mechanically ventilated and enterally fed patients. It is thought that more studies with a larger sample size, randomized controls, blinding methods and a high level of evidence are needed to evaluate the effect of AM on similar or different patient groups. |
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Dergi Adı dc.relation.journal |
Nursing in Critical Care |
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Dergi Sayısı dc.identifier.issue |
5 LIMITATIONS This systematic review has some limitations. The first limitation is that studies on AM that were not randomized controlled or quasi-experimental were not included. The second limitation is that the studies included in this systematic review were small studies with sample sizes of 32–70 participants, and larger studies are needed to fully examine the effect of AM on VAP. The third limitation is that only studies conducted in English were included in the review, and studies conducted in other languages were not included in the review. 6 CONCLUSION In line with these results, AM application has a significant effect in preventing VAP in enterally fed patients on mechanical ventilation. Awareness should be raised to ensure the use of this practice in intensive care units by periodically providing in-service training to intensive care nurses. It is recommended that the study findings be shared in intensive care units to ensure that AM is included in the scope of VAP prevention practices in mechanically ventilated and enterally fed patients. It is thought that more studies with a larger sample size, randomized controls, blinding methods and a high level of evidence are needed to evaluate the effect of AM on similar or different patient groups. |
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Dergi Cilt dc.identifier.volume |
29 |
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Tek Biçim Adres (URI) dc.identifier.uri |
https://hdl.handle.net/20.500.14114/6597 |
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İndekslenen Platformlar dc.source.database |
Web of Science |
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