Objective To explore the efficacy of continuous lateral rotation therapy ( CLRT) for the prevention of ventilator associated pneumonia ( VAP) . Methods Database of Medline and SinoMed were searched. Randomized and controlled trials assessing the efficacy of CLRT vs. placebo or conventional treatment for the prevention of VAP were included. Data were extracted on study population, exclusion and inclusion criteria, diagnostic criteria of VAP, incidence of VAP, ICU mortality, ICU length of stay, andduration of mechanical ventilation. The VAP incidence and mortality were extracted as dichotomous variables and the other parameters were extracted as continuous variables. The pooled analyses of VAP incidence and mortality were performed by using Review Manager 5. 0 software. The heterogeneity was analyzed by thestatistic I2 . Results A total of 5 clinical trials met the inclusion criteria. CLRT could reduce the incidence of VAP ( OR=0. 50,95% CI 0. 32-0. 78) , and the heterogeneity was not statistically significant. The impact of CLRT on the ICU mortality was insignificant. The ICU length of stay and duration of mechanical ventilationwere not significantly different between CLRT and control groups. Conclusion CLRT is beneficial for the prevention of VAP, whereas its impacts on other clinical outcomes such as the ICU mortality, ICU length of stay, and duration of mechanical ventilation require further investigations.
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 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.
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.
Objective To investigate the characteristics of ventilator associated pneumonia (VAP)caused by Stenotrophomonas maltophilia(Sm)in ICU。Methods The clinical data of 39 patients with VAP caused by Sm，from Jan 2001 to Dec 2006，were retrospectively investigated．Results In 15 kinds of antibiotics sensitivity test，all cases showed 100％ resistance to 12 kinds of antibiotics except sulfamethoxazole／trimethoprim。ticarcillin／clavulanic acid and ciprofloxacin with sensitivity rate of 46．2％ ， 30．8％ and 12．8％ ．respectively．92．30％ of Sm VAP were CO—infected with other microorganisms and 79．5％ of VAP were late-onset．The use of broad-spectrum antibiotics．especially carbapenem．and prolonged mechanical ventilation more than 7 days were risk factors for Sm VAP．Morbidity of Sm VAP was 87．2％ ．Conclusions Sm VAP has an important role in ICU infections with high morbidity and CO-infection rate．It should be alerted to the possibility of Sm VAP in the case of when prolonged ventilation (gt;7 days)or carbapenem is used．
ObjectiveTo investigate the incidence of nosocomial infection and device-related infection in the Intensive Care Unit (ICU), analyze its related risk factors, and search for effective measures to prevent and control nosocomial infection. MethodsBy prospective objective monitoring method, we surveyed 294 patients hospitalized in the ICU for at least 48 hours between January and December 2012. The doctor in charge filled in relevant information of the patients to complete the questionnaires, and hospital infection management staff was responsible for tracking, judging, and statistical analysis. ResultsIn the 294 patients, 61 had hospital infections, and there were 78 cases. The hospital infection rate was 20.75%, and the case infection rate was 26.53%. The day incidence of patient infection was 16.01‰, and day infection rate was 20.47‰ for infection cases. After average severity of illness score adjustment, the day case infection rate was 7.48%, ventilator associated pneumonia (VAP) infection rate was 27.27‰, central venous catheter associated bloodstream infection rate was 6.58‰, and catheter associated urinary tract infection rate was 3.15‰. ConclusionICU has a high risk of hospital infection. In the device related infections, VAP infection rate is the highest. Continuous improvement can be achieved through monitoring and discovering problems, strengthening hospital infection management training for the medical personnel of the hospital, close communication between doctors and hospital infection management staff, and strict implementation of hospital infection management measures.