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Gutiérrez JMM, Borromeo AR, Dueño AL, Paragas ED, Ellasus RO, Abalos-Fabia RS, Abriam JA, Sonido AE, Hernandez MA, Generale AJA, Sombillo RC, Lacanaria MGC, Centeno MM, Laoingco JRC, Domantay JAA. Clinical epidemiology and outcomes of ventilator-associated pneumonia in critically ill adult patients: protocol for a large-scale systematic review and planned meta-analysis. Syst Rev 2019; 8:180. [PMID: 31325967 PMCID: PMC6642735 DOI: 10.1186/s13643-019-1080-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 06/25/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND An increasing number of studies have investigated the clinical epidemiology and outcomes of ventilator-associated pneumonia (VAP) in intensive care units. However, these findings have not been clearly defined in broad subgroups of mechanically ventilated adults. Hence, this protocol for a systematic review and meta-analysis is designed to better understand the clinical and epidemiological features of VAP in these patient populations by establishing its overall prognosis of and risk factors for morbidity and mortality and to determine the differences in clinical and economic outcomes between VAP and non-VAP patients. METHODS This present review will systematically search available full-text articles without date and language restrictions and indexed in PubMed, CENTRAL, CINAHL, Web of Science, and EMBASE databases. In addition, reference lists and citations of retrieved articles and relevant medical and nursing journals will be manually reviewed. Supplementary search in other databases involving trials, reviews, and grey literatures, including conference proceedings, theses, and dissertations, will be performed. Study investigators will be contacted to clarify missing or unpublished data. All prognostic studies meeting the pre-defined eligibility criteria will be included. The study selection, risk of bias assessment, data extraction, and grading of the quality of evidence will be carried out in duplicate, involving independent evaluation by two investigators with consensus or a third-party adjudication. The degree of inter-rater agreement will be calculated using the kappa statistic. For meta-analysis, dichotomous and continuous outcome measures will be pooled using odds ratios and standardized mean differences with 95% confidence intervals, respectively. The Mantel-Haenszel or inverse variance methods with random effects model will be used as a guide for analysis. The heterogeneity of each outcome measure will be assessed using both X2 and I2 statistics. In addition, sensitivity and subgroup analyses will be performed to ensure consistency of pooled results. The review protocol described herein is in accordance with the PRISMA-P standards. DISCUSSION The investigation of the epidemiological profiles, prognostic factors, and outcomes associated with VAP is critical for the identification of high-risk groups of mechanically ventilated patients and evaluation of possible clinical endpoints. This may provide substantial links for improved VAP prevention practices targeting modifiable risk factors. Implications for future research directions are discussed. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017048158.
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Affiliation(s)
- John Mark M Gutiérrez
- School of Advanced Studies, Saint Louis University, Baguio, Philippines.
- Department of Nursing, College of Applied Medical Sciences, Shaqra University, Shaqra, Saudi Arabia.
- Division of Epidemiology, Department of Clinical Laboratory Science, College of Applied Medical Sciences, Shaqra University, Shaqra, Saudi Arabia.
| | - Annabelle R Borromeo
- School of Advanced Studies, Saint Louis University, Baguio, Philippines
- Zone 3, Philippine Nurses Association, Quezon City and Marikina City, Philippines
| | - Allan L Dueño
- University of the Philippines Open University, Los Baños, Philippines
| | | | - Rosanta O Ellasus
- School of Advanced Studies, Saint Louis University, Baguio, Philippines
- Department of Nursing, College of Applied Medical Sciences, Shaqra University, Shaqra, Saudi Arabia
| | - Russel S Abalos-Fabia
- Department of Nursing, College of Applied Medical Sciences, Shaqra University, Shaqra, Saudi Arabia
| | - Jerry A Abriam
- Institute of Community Health and Allied Medical Sciences, Don Mariano Marcos Memorial State University, Agoo, Philippines
| | - Arnel E Sonido
- Institute of Community Health and Allied Medical Sciences, Don Mariano Marcos Memorial State University, Agoo, Philippines
| | | | | | | | - Mary Grace C Lacanaria
- School of Advanced Studies, Saint Louis University, Baguio, Philippines
- School of Nursing, Saint Louis University, Baguio, Philippines
| | | | - Jose Reinhard C Laoingco
- Graduate School of Nursing and Allied Medical Sciences, Holy Angel University, Angeles, Philippines
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