Use of Ventilator Care Bundle to Prevent Ventilator-Associated Pneumonia: The Impact of Using Echinacea as a Complementary Modality

Abstract Background: Ventilator Associated Pneumonia (VAP) is one of the most common hospital acquired infections in Intensive Care Unit. It is a complication in many patients who receive mechanical ventilation. One of the recent approaches for prevention of VAP was the application of ventilator care bundle which includes; head of bed elevation, deep vein thrombosis prophylaxis, peptic ulcer disease prophylaxis, daily sedation vacation, daily assessment for readiness for extubation, daily spontaneous breathing trial, and oral care with chlorohexadine. Echinacea is a herb that has been utilized to strengthen the body's innate resistance. It contains multiple active compounds which gives it its medicinal qualities, it has been shown to reduce the severity of respiratory infections. This herb may be used in prophylaxis against VAP. Aim of Study: The objective of this study was to evaluate the effect of adding Echinacea to ventilator care bundle in intubated and ventilated ICU patient on prophylaxis against ventilator associated pneumonia. Material and Methods: This clinical trial included 80 patients who were intubated and mechanically ventilated within 48 hours of admission to ICU in Surgical Intensive Care Unit (SICU) in Kasr Aini Hospital during the period between December 2013 and December 2014. All patients were adults more than 18 years, who have no witnessed aspiration or pneumonia on admission. Intervention: Patients were divided into two equal groups of 40 patients each, one group received Echinacea in the form of Immulant capsules and the other didn't receive it. Both groups have ventilator care bundle applied. All patients were followed-up clinically, radiologically and by laboratory as-sessment. VAP was suggested according to Clinical Pulmonary Infection Score (CPIS). Results: Inflammatory indicators in the form of occurrence of fever and rising trend in the count of WBCs in the first five days were significantly less in the group that received Echinace. Gram negative organisms were the most prevalent in cases with VAP with no statistical difference between both groups in the type of organisms. VAP rate had no significant difference between the two groups. Conclusion: No apparent difference is found on adding Echinacea to ventilator care bundle on prevention of VAP, But Echinacea may be found to decrease severity of inflam-matory reactions reducing VAP complications.