Eficacia de los Bundles de Prevención en la Neumonía Nosocomial: El Rol Determinante del Personal de Enfermería en la Unidad de Cuidados Intensivos. Revisión Sistemática
Resumen
La neumonía asociada a la ventilación mecánica representa un desafío crítico en la Unidad de Cuidados Intensivos, elevando la morbimortalidad y costos hospitalarios. Esta revisión analizo la eficacia de los bundles de prevención, destacando el rol determinante de enfermería en la implementación estricta de protocolos para garantizar la seguridad del paciente. El objetivo de este articulo fue valuar la eficacia de los bundles de cuidados de enfermería en la prevención de la neumonía nosocomial vinculada a ventilación mecánica. Mediante una revisión sistemática de literatura reciente, se determino el impacto de estas intervenciones multidisciplinarias en la seguridad del paciente crítico y la reducción de tasas de infección. Para ello, se realizó una revisión sistemática siguiendo las recomendaciones de la guía PRISMA 2020. Se efectuó una búsqueda en las bases de datos PubMed/MEDLINE, Scopus, Web of Science y Cochrane Library, utilizando términos relacionados con “Ventilator-associated pneumonia”, “Nursing care bundles” e “Intensive Care Unit”. Se incluyeron estudios originales ensayos clínicos y observacionales publicados entre 2020 y 2026, en idiomas español e inglés. Los hallazgos identificó 2526 registros, de los cuales 45 estudios cumplieron los criterios de inclusión. Los estudios incluidos evaluaron pacientes adultos en estado crítico bajo ventilación invasiva, la aplicación de paquetes de medidas preventivas (higiene bucal, control de presión del cuff y elevación de cabecera) y la tasa de incidencia de infecciones. Los principales hallazgos mostraron que la implementación protocolizada del bundle de enfermería reduce significativamente la incidencia de neumonía nosocomial, disminuyendo adicionalmente los días de estancia hospitalaria. La evidencia disponible sugiere que la aplicación estricta y sistemática del care bundle por el personal de enfermería es la estrategia más eficaz para prevenir la neumonía asociada al ventilador.
Descargas
Citas
Adiyeke, E., Koc, B. I., Coskun, N., Bakan, N., Sen, E., Turan, A., & Ozturk, H. (2021). The impact of a multidisciplinary education program for intensive care unit staff regarding ventilator care bundle on the frequency of ventilator-associated events. Dimensions of Critical Care Nursing, 40(4), 210–216. https://doi.org/10.1097/DCC.0000000000000484
Akhter, N., Zhou, X., Elhabashy, S., Huq, K. A. T. M. E., Rahman, M. M., & Moriyama, M. (2025). Evidence-Based Practices to Prevent Ventilator-Associated Pneumonia in an Intensive Care Unit in Bangladesh. Healthcare (Switzerland), 13(21). https://doi.org/10.3390/healthcare13212782
Aktan, G. G., Eşer, İ., & Uyar, M. (2026). Effect of an oral care bundle on salivary pH, dry mouth and ventilator-associated pneumonia in intubated patients: a randomized controlled trial. BMC Oral Health, 26(1). https://doi.org/10.1186/s12903-026-08716-6
Albin, O., Garcia, Z., Troost, J., Weirauch, A., Rao, K., Thompson, K., Stoneman, E., & Kaye, K. (2026). Reductions in ventilator-associated events following implementation of a ventilator-associated pneumonia diagnostic stewardship intervention: A difference-in-difference study. Infection Control and Hospital Epidemiology, 47(3), 318–321. https://doi.org/10.1017/ice.2025.10376
Alfano, A., Riddle, K., Nordstrom, K., Buterakos, R., & Keiser, M. (2024). The impact of nursing education on ventilator-associated pneumonia prevention bundle to reduce incidence of infection: A quality improvement project. Dimensions of Critical Care Nursing, 43(1), 40–46.
https://doi.org/10.1097/DCC.0000000000000615
Al-Harthi, F., Al-Noumani, H., Matua, G. A., Al-Abri, H., & Joseph, A. (2025). Nurses’ compliance to ventilator-associated pneumonia prevention bundle and its effect on patient outcomes in intensive care units. Nursing in Critical Care, 30(3). https://doi.org/10.1111/nicc.70043
Ali Alaswad, Z. M. A., & Bayoumi, M. M. (2022). Implementation of Ventilator-Associated Pneumonia Prevention Bundle among ICU Nurses in Salmaniya Medical Complex, Bahrain: A Quasi-Experimental Study. Journal of the Dow University of Health Sciences, 16(3), 118–124.
https://doi.org/10.36570/jduhs.2022.3.1682
Aloush, S. M., & Al-Rawajfa, O. M. (2020). Prevention of ventilator-associated pneumonia in intensive care units: Barriers and compliance. International Journal of Nursing Practice, 26(5), Artículo e12838. https://doi.org/10.1111/ijn.12838
American Association of Critical-Care Nurses. (2023). AACN procedure manual for high acuity, progressive, and critical care (8.ª ed.). Wolters Kluwer.
https://catalog.nlm.nih.gov/discovery/fulldisplay/alma9916781583406676/01NLM_INST:01NLM_INST
Arumugam, Y., Arulappan, J., & Nandakumar, S. M. (2026). Impact of modified ventilator-associated pneumonia prevention bundle on clinical parameters and outcomes among mechanically ventilated patients: An interventional study. Nursing in Critical Care, 31(1), Artículo e70265.
https://doi.org/10.1111/nicc.70265
Bui Thi Huong Giang, Matsubara, C., Okamoto, T., Hoan, H. M., Yonehiro, Y., Nguyen, D. T., et al. (2025). The development of a 10-item ventilator-associated pneumonia care bundle in the general intensive care unit of a tertiary hospital in Vietnam: Lessons learned. Healthcare, 13(5), Artículo 443. https://doi.org/10.3390/healthcare13050443
Dale, C. M., Rose, L., Carbone, S., Pinto, R., Smith, O. M., Burry, L., Fan, E., Amaral, A. C. K. B., McCredie, V. A., Scales, D. C., & Cuthbertson, B. H. (2021). Effect of oral chlorhexidine de-adoption and implementation of an oral care bundle on mortality for mechanically ventilated patients in the intensive care unit (CHORAL): a multi-center stepped wedge cluster-randomized controlled trial. Intensive Care Medicine, 47(11), 1295–1302. https://doi.org/10.1007/s00134-021-06475-2
Dat, V. Q., Minh Yen, L., Thi Loan, H., Dinh Phu, V., Thien Binh, N., Geskus, R. B., Khanh Trinh, D. H., Hoang Mai, N. T., Hoan Phu, N., Huong Lan, N. P., Phuong Thuy, T., Vu Trung, N., Trung Cap, N., Tuyet Trinh, D., Thi Hoa, N., Thi Thu Van, N., Luan, V. T. T., Quynh Nhu, T. T., Bao Long, H., … Nadjm, B. (2022a). Effectiveness of Continuous Endotracheal Cuff Pressure Control for the Prevention of Ventilator-Associated Respiratory Infections: An Open-Label Randomized, Controlled Trial. Clinical Infectious Diseases, 74(10), 1795–1803.
https://doi.org/10.1093/cid/ciab724
De Pascale, G., Cutuli, S. L., Vargas, M., Cortegiani, A., Dalfino, L., Greco, M., Baroni, S., Esposito, C., Grieco, D. L., Grinberg, R., Lombardi, G., Pota, V., Presti, G., Stufano, M., Tanzarella, E. S., Corcione, A., Pace, C., Sanguinetti, M., Bove, T., … Franchini, E. O. (2026). Personalized automatic management of tracheal cuff pressure and subglottic secretions drainage to prevent pneumonia in critically ill intubated patients. The MICROINHALO multicenter randomized controlled trial. Intensive Care Medicine, 52(6), 1235–1247. https://doi.org/10.1007/s00134-026-08459-6
Du, J., Chencong, N., & Wu, X. (2024). Volume-based subglottic secretion drainage: a randomized controlled trial. Annals of Medicine & Surgery, 86(3), 1426–1432.
https://doi.org/10.1097/ms9.0000000000001695
Güner, C. K., & Kutlutürkan, S. (2022). Role of head-of-bed elevation in preventing ventilator-associated pneumonia bed elevation and pneumonia. Nursing in Critical Care, 27(5), 635–645.
https://pubmed.ncbi.nlm.nih.gov/33884691/
Hoang, H. M., Dao, C. X., Huy Ngo, H., Okamoto, T., Matsubara, C., Do, S. N., Bui, G. T. H., Bui, H. Q., Duong, N. T., Nguyen, N. T., Vuong, T. X., Van Vu, K., Phạm, T. T., & Van Bui, C. (2024). Efficacy of compliance with ventilator-associated pneumonia care bundle: A 24-month longitudinal study at Bach Mai Hospital, Vietnam. SAGE Open Medicine, 12.
https://doi.org/10.1177/20503121231223467
Jo, E., Bae, S., Ryu, S. H., Park, S., Kim, M., Kim, J. Y., Lee, H., Moon, S., Kim, J., Jung, J., & Chong, Y. P. (2026). Effectiveness of toothbrushing as a replacement for chlorhexidine in oral care, combined with head elevation for the prevention of ventilator-associated pneumonia in intensive care units: interrupted time-series analysis. Critical Care, 30(1).
https://doi.org/10.1186/s13054-026-05936-8
Karimi, S., Kolyaei, E., Karimi, P., & Rahmani, K. (2023). Effectiveness of supervised implementation of an oral health care protocol on ventilator-associated pneumonia patients in intensive care units: a double-blind multicenter randomized controlled trial. Infection Prevention in Practice, 5(3). https://doi.org/10.1016/j.infpip.2023.100295
Kes, D., Yildirim, T. A., Kuru, C., Pazarlıoğlu, F., Ciftci, T., & Ozdemir, M. (2021). Effect of 0.12% chlorhexidine use for oral care on ventilator-associated respiratory infections: A randomized controlled trial. Journal of Trauma Nursing, 28(4), 228–234.
https://doi.org/10.1097/JTN.0000000000000590
Lee, H. H., Lin, L. Y., Yang, H. F., Tang, Y. Y., & Wang, P. H. (2021). Application of an automatic medical information system to implement bundle care for the prevention of ventilator-associated pneumonia. International Journal of Environmental Research and Public Health, 18(21).
https://doi.org/10.3390/ijerph182111128
Leong, Y. H., Khoo, Y. L., Abdullah, H. R., & Ke, Y. (2024). Compliance to ventilator care bundles and its association with ventilator-associated pneumonia. Anesthesiology and Perioperative Science, 2(2). https://doi.org/10.1007/s44254-024-00059-1
Martinez-Reviejo, R., Tejada, S., Jansson, M., Ruiz-Spinelli, A., Ramirez-Estrada, S., Ege, D., Vieceli, T., Maertens, B., Blot, S., & Rello, J. (2023). Prevention of ventilator-associated pneumonia through care bundles: A systematic review and meta-analysis. Journal of Intensive Medicine, 3(4), 352–364. https://doi.org/10.1016/j.jointm.2023.04.004
Marjanovic, N., Boisson, M., Asehnoune, K., Foucrier, A., Lasocki, S., Ichai, C., Leone, M., Pottecher, J., Lefrant, J. Y., Falcon, D., Veber, B., Chabanne, R., Drevet, C. M., Pili-Floury, S., Dahyot-Fizelier, C., Kerforne, T., Seguin, S., de Keizer, J., Frasca, D., … Roquilly, A. (2021). Continuous Pneumatic Regulation of Tracheal Cuff Pressure to Decrease Ventilator-associated Pneumonia in Trauma Patients Who Were Mechanically Ventilated: The AGATE Multicenter Randomized Controlled Study. Chest, 160(2), 499–508.
https://doi.org/10.1016/j.chest.2021.03.007
Mogyoródi, B., Skultéti, D., Mezőcsáti, M., Dunai, E., Magyar, P., Hermann, C., Gál, J., Hauser, B., & Iványi, Z. D. (2023). Effect of an educational intervention on compliance with care bundle items to prevent ventilator-associated pneumonia. Intensive and Critical Care Nursing, 75.
https://doi.org/10.1016/j.iccn.2022.103342
Olsen, H. T., Nedergaard, H. K., Strøm, T., Oxlund, J., Wian, K.-A., Ytrebø, L. M., Kroken, B. A., Chew, M., Korkmaz, S., Lauridsen, J. T., & Toft, P. (2020). Nonsedation or Light Sedation in Critically Ill, Mechanically Ventilated Patients. New England Journal of Medicine, 382(12), 1103–1111.
https://doi.org/10.1056/nejmoa1906759
Radhakrishnan, R., Sood, R., Wig, N., Sethi, P., Soneja, M., Kumar, A., Nischal, N., Biswas, A., & Pandey, R. M. (2021). Effect of training and checklist based use of Ventilator Associated Pneumonia (VAP) prevention bundle protocol on patient outcome: A tertiary care centre study. The Journal of the Association of Physicians of India, 69(8), 11–12.
https://pubmed.ncbi.nlm.nih.gov/34472810/
Rahimi-Bashar, F., Gohari-Moghadam, K., & Vahedian-Azimi, A. (2021). Effective Implementation of Ventilator Care Bundles in Improves Outcomes: A Multicenter Randomized Controlled Clinical Trial. Critical Care Explorations, 3(9), E0509.
https://doi.org/10.1097/CCE.0000000000000509
Rosenthal, V. D., Memish, Z. A., & Bearman, G. (2025). Preventing ventilator-associated pneumonia: A position paper of the International Society for Infectious Diseases, 2024 update. In International Journal of Infectious Diseases (Vol. 151). Elsevier B.V.
https://doi.org/10.1016/j.ijid.2024.107305
Saito, S., Thao, P. T. N., Ishikane, M., Xuan, P. T., Kutsuna, S., Dai, H. Q., Ohtsu, H., Kimura, T., Kiyohara, H., Shimada, Y., Maruoka, Y., Thuy, P. T. P., Phu, T. T., Phuong, H. K., Tra, T. T., Duy, N. L. M., Ohara, H., Kurosu, H., Son, N. T., & Ohmagari, N. (2022). Physical oral care prevents ventilator-associated pneumonia in Vietnam: A prospective interventional study. Journal of Infection and Chemotherapy, 28(12), 1632–1638. https://doi.org/10.1016/j.jiac.2022.08.017
Sabino, B. C., Falcão, A. L. E., Coelho, M. S., TerziCoelho, C. B., D'Ottaviano, L., Padovani, R., Santos, F. F. D., & Mello, M. M. (2022). The impact of dental care intervention on ventilator-associate events: A quasi-experimental study. American Journal of Infection Control, 50(9), 1055–1059.
https://doi.org/10.1016/j.ajic.2021.11.026
Sabrah, N. Y. A., Pellegrino, J. L., Mansour, H. E., Mostafa, M. F., & Kandeel, N. A. (2024). Care bundle approach for oral health maintenance and reduction of ventilator-associated pneumonia. Critical Care Nursing Quarterly, 47(4), 335–345. https://doi.org/10.1097/CNQ.0000000000000522
Shehabi, Y., Neto, A. S., Bellomo, R., Howe, B. D., Arabi, Y. M., Bailey, M., Bass, F. E., Kadiman, S. Bin, McArthur, C. J., Reade, M. C., Seppelt, I. M., Takala, J., Wise, M. P., Webb, S. A., Mashonganyika, C., McKee, H., Tonks, A., Donnelly, A., Hemmings, N., … Skelly, C. (2023). Dexmedetomidine and Propofol Sedation in Critically Ill Patients and Dose-associated 90-Day Mortality. American Journal of Respiratory and Critical Care Medicine, 207(7), 876–886.
https://doi.org/10.1164/rccm.202206-1208OC
Singh, C., & Abdullah, R. (2024). Impact of Ventilator-Associated Pneumonia Preventative Measures and Ventilator Bundle Care in a Tertiary Care Hospital’s Adult Intensive Care Unit. Cureus.
https://doi.org/10.7759/cureus.59877
Singh, P., Arshad, Z., Srivastava, V. K., Singh, G. P., & Gangwar, R. S. (2022). Efficacy of Oral Care Protocols in the Prevention of Ventilator-Associated Pneumonia in Mechanically Ventilated Patients. Cureus. https://doi.org/10.7759/cureus.23750
Taner, F., Baddal, B., Theodoridis, L., & Petrovski, S. (2024). Biofilm Production in Intensive Care Units: Challenges and Implications. In Pathogens (Vol. 13, Number 11). Multidisciplinary Digital Publishing Institute (MDPI). https://doi.org/10.3390/pathogens13110954
Tatikonda, C. M., Prasad, K. R. K., Rout, N., Panda, S., Mishra, S. B., Dash, A., Samal, S., & Roy, C. (2023). Teaching Bundle Care Approach to Intensive Care Nurses to Prevent Ventilator Associated Pneumonia with a Stratified Validated Module. Dimensions of Critical Care Nursing, 42(6), 358–365. https://doi.org/10.1097/DCC.0000000000000609
Toulabi, T., Rashnou, F., Hasanvand, S., & Yarahmadi, S. (2020). Promoting the Quality of Ventilator-Associated Pneumonia Control in Intensive Care Units: an Action Research. Tanaffos, 19(3), 223–234. https://pubmed.ncbi.nlm.nih.gov/33815543/
Uma, A. M., Ame, S., Hurisa, S. G., Negawo, M. K., & Seid, S. S. (2026). Clinical outcomes and associated factors among mechanically ventilated patients in adult intensive care unit at Jimma Medical Center, Southwest Ethiopia, 2024. PLOS ONE, 21(4 April).
https://doi.org/10.1371/journal.pone.0341812
Unahalekhaka, A., Uirungroj, P., & Saenjum, C. (2025). Impact of single-use oral care sets on reducing ventilator-associated pneumonia among intensive care unit patients: a multi-centre study. Journal of Hospital Infection, 160, 12–18. https://doi.org/10.1016/j.jhin.2025.03.005
Villagracia, H. N., Alhejaili, T. N., Alshammari, B., Sallam, S. A. E. G., Alrasheeday, A. M., Dando, L. L., Nacubuan, O. A., Alrashedi, H., Nageeb, S. M., Cornejo, L. T. O., Villagracia, R. W. A., Mahmoud, S. K. M., Jacinto-Caspillo, I., Grande, R. A. N., Berdida, D. J. E., & Siam, B. G. A. E. (2025). Intensive and critical care nurses’ compliance, barriers, and challenges with ventilator-associated pneumonia prevention: a cross-sectional study. BMC Nursing, 24(1).
https://doi.org/10.1186/s12912-025-03601-z
Yao, N., Xu, B., Xu, R., Gong, Z., Ma, G., Peng, S., & Zhang, J. (2024). Adult intensive care unit nurses' knowledge of and compliance barriers to evidence-based guidelines for prevention of ventilator-associated pneumonia: A cross-sectional survey. Nursing in Critical Care, 29(6), 1591–1600.
https://doi.org/10.1111/nicc.13162
Zarinfar, N., Ghaznavi-Rad, E., Mahmoodiyeh, B., & Reyhani, A. (2021). Comparison of three interventional approaches to prevent ventilator-associated pneumonia in intensive care units (ICUs): A clinical trial study. In Qatar Medical Journal (Vol. 2021, Number 2). HBKU Press.
https://doi.org/10.5339/QMJ.2021.21
Zhang, C., Wang, X., Mi, J., Zhang, Z., Luo, X., Gan, R., & Mu, S. (2024). Effects of the High-Intensity Early Mobilization on Long-Term Functional Status of Patients with Mechanical Ventilation in the Intensive Care Unit. Critical Care Research and Practice, 2024.
https://doi.org/10.1155/2024/4118896
Zhou, M., Xiao, M., Hou, R., Wang, D., Yang, M., Chen, M., & Chen, L. (2021). Bundles of care for prevention of ventilator-associated pneumonia caused by carbapenem-resistant Klebsiella pneumoniae in the ICU. In Am J Transl Res (Vol. 13, Number 4).
Derechos de autor 2026 Jhomara Lisseth Paucar Ramos , Liliana Lissette Soledispa Moran
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
.png)
.png)
1.png)
