ABSTRACT
Objective To understand the internal circuit contamination of ventilator in mechanical ventilation patients, to evaluate the effect of ventilator internal circuit disinfection and the impact on the incidence of ventilator-associated pneumonia (VAP). Methods A total of 39 patients with mechanical ventilation admitted to intensive care unit (ICU) of Hangzhou Geriatric Hospital from January 2017 to June 2018 were enrolled. Routine mechanical ventilation treatments for patients included pipeline replacement, aseptic operation, prevention of infection, etc. After 2 weeks of mechanical ventilation, the internal circuit of the ventilator was disinfected using the internal circuit sterilizer of the ventilator. Microorganism sampling and detection at 3 cm to the exhalation port of the internal circuit of the ventilator was performed before and after disinfection. The number of colonies was < 5 cfu/cm2 and no pathogenic bacteria could be detected. During the observation period, if the patient was complicated by VAP for anti-infective treatment, the ventilator with internal loop disinfection was replaced after infection control, and was incorporated again into the group for observation. The number of microbial colonies in the internal circuit of the ventilator before and after disinfection, the microbiological test pass rate and the incidences of VAP during the 2 weeks were observed. Results All 39 patients were included in the analysis, with 23 male and 16 female; with age of 65-97 years old, average (78.7±7.6) years old. Before the disinfection, 9 604 strains were detected in the internal circuit of the ventilator, including 8 687 strains of Gram-negative bacilli (90.4%), 902 strains of Gram-positive cocci (9.4%), and 15 strains of fungi (0.2%), which were detected in the lower respiratory tract of the patients. The strain concordance rate was 41%. The qualified rate of microbial detection in the internal circuit of the ventilator was 5.1%; 13 cases (33.3%) of VAP occurred during 2 weeks of mechanical ventilation. After disinfection, 785 strains of pathogens were detected in the internal circuit of the ventilator, and the number of colonies was significantly reduced compared with that before disinfection [cfu/cm2: 0 (0, 20) vs. 150 (15, 500), P < 0.01], of which 688 strains of Gram-negative bacilli (87.7%), 92 strains of Gram-positive cocci (11.7%) and 5 strains of fungi (0.6%) were found; the qualified rate of microbial detection in the internal circuit of ventilator reached 71.8%, which was significantly higher than that before disinfection (P < 0.01); 2 weeks after mechanical ventilation the incidence of VAP decreased slightly during the period [20.5% (8/39) vs. 33.3% (13/39)], but there was no significant difference (P > 0.05). Conclusions The internal circuit of the ventilator can be used to detect the pathogen and the sputum culture of the patients on mechanical ventilation with a high consistency. The disinfection of the pathogen could significantly reduce the air pollution of the ventilator and reduce the occurrence of VAP in the patients.
ABSTRACT
Objective To investigate the clinical efficacy ofω-3 unsaturated fatty acid enteral nutrition (EN) for treatment of elderly patients with heart failure (HF). Methods One hundred and twenty six elderly patients with HF admitted to Hangzhou Geriatric Hospital from April 2013 to April 2018 were enrolled to be the study objects, and they were divided into a TPF group and a TPF-T group (63 cases in each group) according to the difference in nutrition preparation. The nasal feeding with EN solution rich in ω-3 unsaturated fatty acid was applied in the TPF-T group; while in the TPF group, nasal feeding with common EN solution was given. According to the body mass quantity to calculate the necessary heat standard, the target energy established for the two groups was 104.6-125.5 kJ·kg-1·d-1. The changes of levels of albumin (Alb), prealbumin (PA), transferrin (TRF), interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), T lymphocyte subsets such as CD3+, CD4+, CD8+, CD4+/CD8+, plasma N-terminal pro-brain natriuretic peptide (NT-proBNP), and left ventricular ejection fraction (LVEF) were observed in the two groups before and after treatment, and the prognostic indexes and incidence of adverse reactions of the two groups were also observed. Results After treatment, the levels of Alb, PA, TRF, and the immune function indexes CD3+, CD4+, CD8+, CD4+/CD8+ were significantly increased in both groups (all P < 0.05), while the serum levels of IL-6, hs-CRP, TNF-α and NT-proBNP were obviously decreased in both groups (all P < 0.05), moreover, the degrees of changes in the above parameters in the TPF-T group were more significant than those in the TPF group [Alb (g/L):36.91±4.49 vs. 36.31±3.95, PA (mg/L): 190.26±15.39 vs. 188.51±17.62, TRF (g/L): 2.31±0.44 vs. 2.25±0.71, IL-6 (ng/L): 312.53±42.69 vs. 372.45±51.25, hs-CRP (mg/L): 20.43±15.72 vs. 35.81±14.28, TNF-α (ng/L):81.36±17.32 vs. 152.67±21.71, CD3+: 0.59±0.06 vs. 0.55±0.05, CD4+: 0.33±0.05 vs. 0.28±0.04, CD8+:0.23±0.03 vs. 0.21±0.04, CD4+/CD8+: 1.55±0.34 vs. 1.36±0.41, NT-proBNP (ng/L): 149.00±0.38 vs. 242.00±0.56, all P < 0.05]; the intensive care unit (ICU) length of stay, the total hospital length of stay in the TPF-T group were significantly shorter than those in the TPF group [ICU length of stay (days): 9.41±3.19 vs. 12.39±3.75, total hospital length of stay (days): 15.24±4.63 vs. 18.26±5.18, both P < 0.05], and the incidence of adverse reaction in TPF-T group was lower than that in the TPF group: [4.76%(3/63) vs. 17.46% (11/63), P < 0.05]. However, there was no statistical significant difference in left ventricular ejection fraction between the TPF-T group and TPF group (LVEF: 0.418±0.053 vs. 0.417±0.052, P > 0.05). Conclusion Early application of ω-3 unsaturated fatty acid EN may improve the immunologic function of T lymphocytes as well as prognosis, reduce the inflammatory response in elderly patients with HF, and reduce the incidence of adverse reactions.
ABSTRACT
Objective To approach the nursing experience and clinical therapeutic effect of using aerosol inhalation of Scutellaria baicalensis leachate to prevent occurrence of ventilator-associated pneumonia (VAP) in critically ill patients in intensive care unit (ICU). Methods Ninety-two severe patients who received mechanical ventilation (MV) in ICU of Hangzhou Geriatric Hospital from April 2016 to August 2017 were enrolled, and they were divided into a test group and a control group according to their wishes and self-selection, 46 cases in each group. The patients in both groups were given fine nursing care model, in the control group aerosol inhalation of physiological saline was used; in the test group aerosol inhalation of Scutellaria baicalensis leachate was applied. The incidence of VAP, the duration of MV and time of ICU stay were compared between the two groups. Results Compared to the control group, the total incidence of VAP, duration of MV, time of ICU stay in the test group were significantly lower than those in control group [total incidence of VAP: 17.39% (8/46) vs. 36.95% (17/46), duration of MV (days): 11.37±5.23 vs. 15.21±5.93, time of ICU stay (days): 18.54±5.92 vs. 27.33±5.27, all P < 0.05]. Conclusion Under the fine nursing care pattern, compared with the aerosol inhalation of saline, the aerosol inhalation of Scutellaria baicalensis leaching can be more effectively to prevent VAP in ICU critically ill patients and reduce their duration of MV and of ICU stay, so the latter one's clinical therapeutic effect is better.