Objective To explore the effectiveness and safety of self-made washable endotracheal tube for subglottic secretion drainage. Methods Ordinary endotracheal tube and sputum aspirating tubes were used to make washable endotracheal tube for subglottic secretion drainage in our hospital. The self-made tubes were compared with washable endotracheal tube available on the market. The suction resistance, the cases of obstruction in the tubes, the average daily drainage, and the cases of infection of incisional wound were compared between the two kinds of tubes, and their safety was evaluated. Results After three days of application, the suction resistance of endotracheal tube available on the market increased, with six cases of the blockage of the lumen ( 85% ) , while that of self-made endotracheal tube did not change, with no cases of blockage ( 0% ) . There was significant difference between these two kinds of tubes ( P lt;0. 01) . The average daily drainage in the former was ( 16. 55 ±8. 66) mL/d; while that in the latter was ( 40. 12 ±25. 48) mL/d. There was no significant statistical difference between the two kinds of tubes ( P gt;0. 05) . The incidence ofinfection of incisional wound in the ordinary endotracheal tube was 50% ( 5 cases) ; that in the tubes available on the market was 28% ( 2 cases) ; that in the self-made tubes was 15% ( 2 cases) . There was significant difference among the three groups. When tube cuffs were inflated, the distance between the back edge of suction tubes and tube cuffs was was 2-4 mm. Conclusion Self-made washable endotracheal tubes are effective for subglottic secretion drainage with good safety and low price.
Objective To compare the humidification effect of the MR410 humidification system and MR850 humidification system in the process of mechanical ventilation. Methods Sixty-nine patients underwent mechanical ventilation were recruited and randomly assigned to a MR850 group and a MR410 group. The temperature and relative humidity at sites where tracheal intubation or incision, the absolute humidity, the sticky degree of sputum in initial three days after admission were measured. Meanwhile the number of ventilator alarms related to sputum clogging and pipeline water, incidence of ventilator associated pneumonia, duration of mechanical ventilation, and mortality were recorded. Results In the MR850 group,the temperature of inhaled gas was ( 36. 97 ±1. 57) ℃, relative humidity was ( 98. 35 ±1. 32) % , absolute humidity was ( 43. 66 ±1. 15) mg H2O/L, which were more closer to the optimal inhaled gas for human body.The MR850 humidification system was superior to the MR410 humidification system with thinner airway secretions, less pipeline water, fewer ventilator alarms, and shorter duration of mechanical ventilation. There was no significant difference in mortality between two groups. Conclusions Compared with MR410 humidification system, MR850 humidification system is more able to provide better artificial airway humidification and better clinical effect.
ObjectiveTo explore the preventive role of maintaining constant pressure of the endotracheal catheter cuff on ventilator-associated pneumonia (VAP). MethodsFrom January to December 2015, 96 patients of type Ⅱ respiratory failure were selected as the trial group who underwent intubation and mechanical ventilation more than 48 hours in the Intensive Care Unit (ICU). We used pressure gauges to measure the endotracheal catheter cuff pressure regularly and maintained a constant pressure in addition to the application of artificial airway cluster management. We recorded the initial pressure value which was estimated by pinching with finger and set initial pressure to 30 cm H2O (1 cm H2O=0.098 kPa). We measured endotracheal catheter cuff pressure and recorded it during different intervals. We reviewed 88 patients with the same disease as the control group who only accepted artificial airway cluster management between January and December 2014. Mechanical ventilation time, VAP occurrence time, ICU admission time, the incidence of VAP were recorded and analyzed for both the two groups of patients. ResultsIn the trial group, the initial pressure of endotracheal catheter cuff which was estimated by pinching with finger showed that only 11.46% of pressure was between 25 and 30 cm H2O and 82.29% of the pressure was higher than 30 cm H2O. We collected endotracheal catheter cuff pressure values during different interval time by using pressure gauges to maintain a constant management. The ratio at the pressure between 25 and 30 cm H2O was respectively 41.32%, 43.75%, 64.20%, 76.54%, 91.13%, and 91.85%. ICU admission time, mechanical ventilation time in patients of the trial group decreased more, compared with the control group, and the differences were statistically significant (t=4.171, P<0.001; t=4.061, P<0.001). The VAP occurrence time in patients of the trial group was later than the control group (t=2.247, P<0.001). ConclusionThe endotracheal catheter cuff pressure estimated by pinching with finger has errors. We recommend using pressure gauges to detect pressure every four hours, which utilizes minimal time to maintain effective pressure. The method of artificial airway of cluster management combined with the pattern of maintaining constant endotracheal catheter cuff pressure can shorten ICU admission time, mechanical ventilation time and delay the occurrence of VAP.
ObjectiveTo investigate the causes of ventilator-associated pneumonia (VAP) in patients with tumor in Intensive Care Unit (ICU), and take effective intervention measures to reduce the incidence of VAP. MethodsThe targeted monitoring was conducted for the ICU patients who underwent the mechanical ventilation for over 48 hours from January 2013 to December 2014. Then the conventional nursing measures where adopted in 2013 without any field intervention measure implemented. While the prevention and control method was conducted in 2014 and the causes of VAP was valued and anyzed. ResultsAfter adopting intervention measures, the thousand-day rate of VAP decreased from 8.71‰ before the interventions to 2.30‰ after the interventions. The utilization rate of ventilators increased from 63% to 72% after the interventions were taken in 2014. The constituent ratio of the multidrug-resistant bacteria among the isolated pathogens in each year presented a downward trend. ConclusionVAP is common in ICU patients. It is necessary to reach preventive measures and designated position and ventilator management so as to prevent the occurrence of new nosocomial infection.
For a long time, the monitoring of ventilator-associated pneumonia (VAP) has many drawbacks, such as complex diagnostic criteria, high subjectivity, low comparability, low attributable mortality, and difficulty in automated monitoring. The U.S. Center for Disease Control and Prevention proposed a new monitoring definition of ventilator-associated event (VAE) in January 2013 to address the existing problems of VAP. VAE monitoring can better predict the adverse prognosis of patients, adopt objective diagnostic criteria, and realize automatic monitoring. However, VAE surveillance also has some shortcomings: poor identification of VAP patients, lack of sufficient evidence of preventive strategies so far, inconclusive application in neonates and children groups, as easy to be interfered with as VAP. The applicability of VAE in China, its risk factors and preventive strategies need to be further studied.
呼吸机相关性肺炎( VAP) 是指患者接受机械通气治疗48 h 后至停用机械通气、拔除人工气道后48 h 内发生的肺实质的感染性炎症。为接受机械通气患者最常见的院内感染。VAP的发生率和病死率由于诊断手段不同, 报道不一。国外报道, VAP 发生率为9% ～70% [ 1] , 病死率高达20% ～71% [ 2, 3] ; 国内医院调查, VAP发生率为48. 5% , 病死率为37. 5% [ 4] 。患者一旦发生VAP, 易造成撤机困难, 并可导致患者在ICU的停留时间及住院时间延长, 增加相关的医疗费用, 严重者可导致患者死亡。因此, VAP的早期预防、早期诊断和治疗就显得非常重要, 本文就近年来VAP 的诊治现状做一概述, 以供同道参考。
ObjectiveTo systematically review the efficacy of closed and open tracheal suction system on the prevention of ventilator-associated pneumonia.MethodsThe Cochrane Library, CNKI, WanFang Data, Airiti Library, PubMed, CINAHL and Proquest databases were electronically searched to collect randomized controlled trials (RCTs) on closed and open tracheal suction system on the prevention of ventilator-associated pneumonia. Two reviewers independently screened literature, extracted data, and assessed the risk bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 11 RCTs involving 1 187 patients were included. The results of meta-analysis showed that compared with open tracheal suction system, closed tracheal suction system was associated with a reduced incidence of ventilator-associated pneumonia (RR=0.55, 95%CI 0.44 to 0.67, P<0.000 01), late-onset ventilator-associated pneumonia (RR=0.47, 95%CI 0.28 to 0.80, P=0.005), length of stay in intensive care unit (MD=−0.85, 95%CI −1.66 to −0.04, P=0.04) and rate of microbial colonization (RR=0.69, 95%CI 0.56 to 0.86, P=0.000 9). However, there were no significant differences between two groups in time to ventilator-associated pneumonia development (MD=0.96, 95%CI −0.21 to 2.12, P=0.11), length of mechanical ventilation (MD=−2.24, 95%CI −4.54 to 0.06, P=0.06), and rate of mortality (RR=0.88, 95%CI 0.73 to 1.05, P=0.15).ConclusionsCurrent evidence shows that compared with open tracheal suction system, closed tracheal suction system can reduce the incidence of ventilator-associated pneumonia and late-onset ventilator-associated pneumonia, shorten the hospital stay in intensive care unit, and reduce rate of microbial colonization. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To investigate the effect of a real-time compliance dashboard to help reduce ventilator-associated pneumonia ( VAP) with ventilator bundle. Methods 240 patients who were admitted into the intensive care unit ( ICU) of Shougang Hospital of Peking University and had received mechanical ventilation ( MV) for over 48 hours, between January 2010 and November 2011, were studied prospectively. The patients were divided into two groups by random number table, ie. a dashboard group ( n = 120) with implementation of a real-time compliance dashboard to help reduce VAP with ventilator bundle, and a control group ( n=120) with implementation of usually routine order to help reduce VAP with ventilator bundle. The success rate of ventilator bundle implementation, incidence of VAP, duration of MV, duration within ICU, mortality within 28 days, cost within ICU were compared between two groups. Results Compared with the control group, the success rate of ventilator bundle implementation obviously increased ( 81.6% vs. 52.5%) , incidence of VAP ( 14. 5/1000 days of MV vs. 36.2 /1000 days of MV) , duration of MV [ 5( 4,7) days vs. 8( 6,11) days] , duration within ICU [ 8( 6,12) days vs. 13( 8,16) days] , mortality of 28 days ( 12.6% vs. 28.6% ) , and cost within ICU ( 36,437 vs. 58,942) in the dashboard group obviously reduced ( Plt;0.05) . Conclusions Implementation of a real time compliance dashboard to help reduce VAP with ventilator bundle can obviously improve medical personnel compliance and reduce incidence of VAP, duration of MV, duration within ICU, mortality and cost in ICU than those of routine medical order to help reduce VAP with ventilator bundle.
为预防应激性溃疡和消化道出血, 质子泵抑制剂( PPI) 、组胺H2 受体拮抗剂( H2 RA) 以及硫糖铝在ICU中的应用非常普遍。既往的研究认为以PPI 或H2RA 为代表的抑酸剂( ASD) 可致胃液pH 值增高, 为细菌在胃腔内定植创造了条件, 并进而增加医院获得性肺炎( HAP) , 尤其是呼吸机相关性肺炎( VAP) 发生的风险。我们通过文献复习发现,ASD 与VAP 的关联性迄今仍无明确的证据, 已有的临床研究结论互为矛盾; 另一方面, 既往研究多集中于硫糖铝与H2RA 的比较, 有关PPI 和H2RA 导致VAP 的风险比较研究仍然缺乏, PPI 是否比H2 RA 更易发生VAP 也缺乏研究可资证明。为此我们将有关内容综述如下, 以供同道参考。