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Introducción. Las cardiopatías congénitas (CC) en Chile corresponden a la segunda causa de muerte en menores de 1 año, requiriendo cirugías paliativas y/o correctivas el 65% de estas. En el post operatorio frecuentemente se utiliza ventilación mecánica invasiva (VM) y succión endotraqueal (SET) para remover secreciones. Sin embargo, la kinesiología respiratoria (KTR) ha mostrado mejoras significativas en la distensibilidad toracopulmonar (Cest) y resistencia de vía aérea (Rva) en otros grupos de usuarios pediátricos y adultos en VM. Objetivo. Comparar los cambios en la Cest y Rva en usuarios pediátricos en VM post cirugía de cardiopatía congénita (CCC) sometidos a KTR versus SET exclusiva. Métodos. Revisión sistemática de estudios publicados en bases de datos PUBMED, PeDro, Scielo y Google Scholar que comparan el uso de KTR ó SET sobre los cambios en mecánica ventilatoria en usuarios pediátricos en VM post cirugía de cardiopatía congénita, limitados a inglés, español y portugués, excluyendo a sujetos con traqueostomía o con oxigenación por membrana extracorpórea. Se utilizó guía PRISMA para la selección de artículos. Se revisaron 397 artículos y se seleccionó 1 artículo extra de los artículos sugeridos. Se eliminó 1 artículo por duplicidad. Por títulos y resúmenes se seleccionaron 2 artículos, los cuales al leer el texto completo fueron retirados debido a que la población no correspondía a cardiópatas. Resultados. El final de artículos seleccionados fue de 0 artículos, debido a lo cual se removió el operador Booleano "NOT", y se removió la población de cardiopatías. De este modo quedaron 2 artículos seleccionados para la revisión cualitativa final donde se compara KTR versus SET, y KTR en kinesiólogos especialistas y no especialistas, mostrando ambos aumento en la Cest y disminución de la Rva a favor de la KTR, hasta los 30 minutos post intervención. Conclusiones. No se encontraron artículos que demuestren cambios en Cest y Rva con el uso de KTR + SET versus SET exclusiva, en usuarios pediátricos ventilados posterior a CCC. Con la remoción de filtros seleccionamos 2 artículos que demuestran aumento de Cest y disminución de Rva en sujetos pediátricos en VM, uno comparando con SET, y por grupos de especialistas y no especialistas en respiratorio. Se sugieren estudios primarios para evaluar los efectos de esta intervención en esta población.
Introduction. Congenital heart diseases (CHD) are the second general cause for children death under 1 year. In Chile, approximately 65% CHD need surgery, could was palliative or corrective. In the postoperative period, invasive mechanical ventilation (MV) is frequently used as a life support method, but it is associated with complications. Tracheal suction (SET) is regularly used to remove secretions; however, respiratory chest physiotherapy (KTR) has shown significant improvements in thoraco-pulmonary compliance and airway resistance in other groups of pediatrics and adult's users in MV. Objetive. to compare changes in thoraco-pulmonary compliance and airway resistance in pediatric subjects under mechanical ventilation after congenital heart disease surgery comparing chest physiotherapy and exclusive tracheal suction. Methods. systematic review of studies published in PUBMED, PeDro, Scielo and Google Scholar databases who compares KTR or SET use on changes in ventilatory mechanics in pediatric users under MV after congenital heart disease surgery, limited to English, Spanish and Portuguese languages, excluding user with tracheostomy or extracorporeal membrane of oxygenation. It was use the PRISMA guide to articles selection. A search was carried out, with a total of 397 articles reviewed (English: PubMed = 3, PeDro = 8, Scholar = 383; Spanish: Scholar = 3, Scielo = 0; and Portuguese: Scielo = 0). One extra article was selected from the suggested articles, and 1 article was eliminated due to duplication. By titles and abstracts, 2 articles were selected, but the population did not correspond to heart disease. Results. the final selected articles were 0 articles. By this reason, it were removed: Boolean operator "NOT", and congenital heart disease population. Thus, 2 articles were selected for the final qualitative review where it was compares KTR versus SET, and KTR by specialist and non-specialist. Both articles shown improvement in compliance and resistance until 30 minutes post intervention. The CC population was in a 40 to 60% range in both studies. Conclusions. it was no found articles that demonstrate changes in compliance and resistance in the airway with the use of KTR + SET versus exclusive SET in pediatric users after CCC connected to MV. After filter remotion, we found 2 studies shown improves in increase compliance and reduce resistance in pediatric user in MV, ones comparing with SET, and the other one comparing between specialists in respiratory pediatric physiotherapy and not specialists. It suggests to made primary clinical studies about this intervention in CC population.
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BACKGROUND: Endotracheal suctioning is associated with complications that include bleeding, infection, hypoxemia, cardiovascular instability, and tracheal mucosal injury. Recently, a closed-suction catheter with a pressure valve (Acetrachcare, AceMedical Co., Republic of Korea) was developed. We hypothesized that this new catheter might reduce tracheal mucosal injury compared to a conventional closed-suction catheter (Trachcare, Kimberly-balla RD, USA). METHODS: This prospective, randomized study enrolled medical and surgical patients who required mechanical ventilation for more than 48 hours. Patients were randomized into two groups: one group was suctioned with the conventional closed-suction catheter (CCC) and the other group was suctioned with the closed-suction catheter with pressure valve (CCPV). Bronchoscopy was performed 48 hours later, and the severity of tracheal mucosal injury was graded on a 5-point scale, as follows: 0 = normal; 1 = erythema or edema; 2 = erosion; 3 = hemorrhage; and 4 = ulceration or necrosis. RESULTS: A total of 76 patients (37 with CCPV and 39 with CCC) were included. There were no significant differences between the groups regarding demographic characteristics, changes in hemodynamic parameters during suction, incidence of pneumonia, length of intensive care unit (ICU) stay, or ICU mortality. On bronchoscopic evaluation, the use of the CCPV led to a significant decrease in tracheal mucosal injury (median tracheal mucosal injury grade 1 [IQR 0-1] vs. 2 [IQR 1-3], p = 0.001). CONCLUSIONS: We conclude that the novel closed-suction catheter with pressure valve may reduce tracheal mucosal injury compared to conventional catheters.
Subject(s)
Humans , Hypoxia , Bronchoscopy , Catheters , Edema , Erythema , Hemodynamics , Hemorrhage , Incidence , Intensive Care Units , Mortality , Necrosis , Pneumonia , Prospective Studies , Respiration, Artificial , Suction , UlcerABSTRACT
Objective To investigate the effect on incidence of ventilator associated pneumonia(VAP),the cost of hospitalization with closed endotracheal suctioning and vital sign as well in postoperative cardiac patients.Methods 304 postoperative cardiac patients supporting by ventilation were enrolled in this cohort study during January,2012-November,2013 in The Second affiliated Hospital& Yuying Children Hospital of Wenzhou Medical University.All the subjects were randomly divided into observational group and control group by coin side.Closed endotracheal suctioning system was applied in observation group and opened mode was applied in control group.Compare the vital sign(heart rate,blood pressure,saturation) at the moment of aspiration,suction time,incidence of VAP,duration of ventilation,mortality,the cost of suction,hospital stays and hospitalization expense.Results The baseline is no significant difference between two groups.The fluctuation of blood pressure and heart rate is lower in observational group at 30 second since completed the suction(P ＜0.05),but saturation is higher at 30 second and 60 second since completed the suction respectively(P ＜ 0.05).There is no significant difference of incidence of unexpected tube displacement and pneumothorax between two groups.Average time of each suction of experimental groups is shorter than Control groups[(156 ± 6) s vs (225 ± 8) s,t =-84.86,P ＜ 0.01].VAP incidence is lower in experimental group (12.0％ vs.18.6％,x2 =4.37,P ＜ 0.05).Duration of ventilation is lower in experimental group[(72 ± 33) h vs.(98 ± 38) h,t =-6.35,P ＜ 0.05].The cost of suction is higher in observational group [(346 ± 15) RMB vs.(178 ± 26) RMB,t =69.00,P ＜ 0.01],but the hospitalization expense is lower in experimental group [(32 011 ± 2 525) yuan vs.(35 264 ± 3 846)yuan,t =-8.72,P ＜ 0.05].There is no significant difference in mortality between two groups (x2 =0.08,P ＞ 0.05).Conclusion Application of closed endotracheal suction system can result in reduction vital sign fluctuation and incidence of cross infection and reducing the workload of nurses and decreasing the complication of suction,shorting the duration of ventilation and hospitalization and saving the expense of hospitalization in postoperative cardiac patients comparing with open mode.It is worthy to be populized in cardiac care unit.
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ObjectiveTo investigate the feasibility,safety and efficacy of tracheal extubation with directly connected negative pressure suction. Methods86 patients with Ⅰ or Ⅱ degree of ASA,aged 18～65 years old,without history of respiratory disease,difficult airway and ventilation problems were involved in this study.All patients undergoing endotracheal general anesthesia were randomly divided into group A and B with 43 cases in each group.Group A used negative pressure directly connected to external side of the endotracheal tube before extubation.Group B used suction tube putting into the endotracheal tube before extubation.MAP,HR,ECG,SpO2,the condition of cough and expectoration and complicatons after extubation were recorded. ResultsIn group A the MAP,HR slightly increased,SpO2 slightly decreased,ECG showed no significant change,but the differences were not significant.In group B,MAP,HR,SpO2 showed significant difference compared with those before extubation and the corresponding period of group A. ConclusionsThe method that connecting negative pressure suction with endotracheal tube can effectively reduce the cardiovascular response during extubation,It also can avoid hypoxia,reduce the tracheobronchial injury and pulmonary complications.It's a practical good method in tracheal extubation.
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Objective To evaluate the effect of postural drainage assisting trachea suction on meconium aspiration syndrome. Methods Total 61 cases of asphyxia neonates with MAS who were born in our hospital from Jan,2007 to Dec,2008, were divided into control group (24 cases) and observing group( 37 cases). The neonates in control group had endotracheal suction directly after intubation. But the infant in observing group was treated with endotracheal suction after postural drainage. The amount of suction from endotracheal tube,the complication of MAS and the outcome of these newborns were evaluated. Results The total amount of meconium drainage from endotrachea in observing group was statistics significantly more than that in control group [( 2. 16 ± 1.82) ml vs ( 1.23 ± 0. 97 ) ml, P ＜ 0. 05 )]; The intubating times in observing group were statistical significantly less than that in control group[( 1.19 ± 0. 46) vs ( 1.79 ± 0. 83 ) times, P ＜0. 01 ). The incidence of complication in observing group was 8. 11% ,which was significantly lower than that in control group(29. 17% ,P ＜0. 05). There were shorter needing oxygen time [(21.30 ± 22. 38) h vs (52. 91 ±39. 20) h,P ＜0. 01]and shorter hospitalization days [(9. 24 ±3.94) d vs ( 14. 39 ±6. 49) d,P ＜0.01 )]in observing group than those in control group respectively. The mortality in control group was 4. 17%, and no death occurred in observing group. Apgar scores of the first minute was similar in both groups ( P ＞ 0. 05 ). But there was significant difference(70. 16% vs 58. 34% ,respectively;P ＜0. 05) in the fifth minute Apgar scoring of 8 ～ 10 scores between the observing group and the control group. Conclusion Postural drainage assisting endotracheal suction may remove meconium in trachea effectively, decrease the complications of MAS and shorten the oxygen days and hospitalization time.
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BACKGROUND: We performed a prospective, randomized, and controlled trial to evaluate the effect of an intravenous fentanyl and propofol on the variation in BIS level associated tracheal suction. METHODS: Thirty ICU patients intubated or tracheostomized were randomly allocated to control and experimental groups. Control group was received saline and experimental groups were received propofol with or without fentanyl intravenously prior to tracheal suction. And then we monitored BIS index, blood pressure, heart rate and SpO2 before, during and after tracheal suction. RESULTS: BIS index was significantly lower in propofol plus fentanyl group than others during experiment (P < 0.05). Heart rate and blood pressure in propofol plus fentanyl group also less increased than those in control or propofol group during tracheal suction (P < 0.05). CONCLUSIONS: These results suggest that co-administration of propofol and fentanyl has more effective than propofol alone in sedation and analgesia of ICU patients during tracheal suction.
Subject(s)
Humans , Analgesia , Blood Pressure , Fentanyl , Heart Rate , Propofol , Prospective Studies , SuctionABSTRACT
BACKGROUND: The aim of this study was to evaluate the influence of an improved method of endotracheal suction on nosocomial pneumonia (NP) and tracheal colonization by Pseudomonas aeruginosa and Acinetobacter baumannii in intensive care units (ICUs). METHODS: The study was carried out in both the medical and surgical ICUs of a tertiary-care university hospital; 2,347 patients were admitted in the ICUs from January 2003 to December 2004. The method of endotracheal suction to remove secretions was improved by using a sterile, individually packed catheter and sterile fluid filled in a small container for a single use instead of sterile catheters and fluid packed or filled in large containers for a multiple use. Then, we compared the incidence of NP, the colonization rates of P. aeruginosa and A. baumanni in the respiratory tract, and their carbapenem resistance before and after the intervention. RESULTS: The incidence of NP (1,000 patient-day rate) was decreased from 4.08 to 2.46 in the SICU and from 1.4 to 0.8 in the MICU after the intervention, but the differences were not significant. The colonization rate by A. baumannii was decreased significantly from 35.7% to 4.6% in the SICU (P<0.001) and from 12.7% to 7.6% in the MICU (P<0.001). The colonization rate by P. aeruginosa was decreased significantly from 17.7% to 7.4% in the SICU (P<0.001), but not in the MICU. There was also a marked decrease in carbapenem resistance, 21% to 8% in P. aeruginosa and 70% to 16% in A. baumannii. CONCLUSION: Endotracheal suction with a sterile catheter and sterile fluid is important in preventing respiratory infections and colonization by P. aeruginosa and A. baumannii in the ICU.
Subject(s)
Humans , Acinetobacter baumannii , Acinetobacter , Catheters , Colon , Drug Resistance, Bacterial , Incidence , Intensive Care Units , Critical Care , Pneumonia , Pseudomonas aeruginosa , Pseudomonas , Respiratory System , Respiratory Tract Infections , SuctionABSTRACT
PURPOSE: The purpose of this study was to examine the effects of a closed endotracheal suction system(CES) on oxygen saturation, ventilator associated pneumonia(VAP), and nursing efficacy in mechanically ventilated patients. METHOD: This study was conducted in the intensive care unit of a University Hospital in Gwangju City. Data was collected from July to October, 2003. Seventy mechanically ventilated patients were randomly divided into two groups; 32 for CES and 38 for open endotracheal suction system(OES) protocol. Twenty one nurses were also involved to examine the nurses' attitude of usefulness about CES. RESULT: SaO2 was significantly different between CES and OES. The incidence of VAP in CES was lower than that of OES. Nursing efficacy was related to time, cost, and usefulness of the suction system. Time of suctioning in CES was shorter than that of OES. CES also contributed significantly to lower the cost of treatment than OES. The usefulness score of CES increased after 6 months of use. CONCLUSION: CES prevented VAP, was cost effective, and a safe suctioning system. CES ncan be used with patients with sensitivity to hypoxygenation and with a high risk of VAP.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Cross Infection/etiology , Intubation, Intratracheal/adverse effects , Nursing Care/standards , Pneumonia/etiology , Respiration, Artificial/adverse effectsABSTRACT
OBJECTIVE: The purpose of this study was to identify the effects of tracheal suction and the effects of different methods of bronchodilator inhalation (Ultrasonic nebulizer, MDI puff, MDI puff with spacer) in VSD surgery patients. MATERIAL & METHOD: From June 2001 to March 2002, sixty consecutive patients were randomly assigned to a control group (n= 15), ultrasonic nebulizer group (n=15), metered dose inhalation (MDI) puff group (n=15) and MDI with spacer group (n=15). Vital signs (HR, BP, CVP), ABGA and pulmonary functions were measured before suction (baseline for suction), after suction, 15 minutes after suction (base of bronchodilator inhalation), 30 minutes after bronchodilator inhalation, and 2 hours after bronchodilator inhalation. Stastistical analysis was performed using SPSS software. Repeated measure ANOVA was used to examine the effects of tracheal suction. One way ANOVA with Bonferroni's correction and mutiple range test (the least significant difference test) were used to examine the effects of albuterol inhalation. RESULT: 1. Heart rate increased significantly immediately after suction (p<0.01) and recovered 15 minutes after suction. 2. PaO2 and PH decreased significantly immediately after suction (p<0.05) and PaO2 recovered 15 minutes after suction. PaCO2 increased immediately after suction and significantly 15 minutes after suction (p<0.01). But changes in vital signs and ABGA were within the normal range. 3. Tidal volume decreased significantly 15 minutes after suction (p<0.05) 4. Changes of HR and tidal volume were greater in the nebuizer group compared to the other groups (p<0.05) 30 minutes after bronchodilator inhalation and recovered 2 hours after bronchodilator inhalation. 5. Changes of airway deadspace was greater in the nebulizer group compared to the control group and MDI puff group 30 minutes after albuterol inhalation (p<0.05) and at 2 hours (p<0.01). CONCLUSION: Tracheal suction did not have significant effect on vital signs and pulmonary functions after OHS. Although the methods of bronchodilator inhalation did not showed any significant difference on pulmonary function, the nebulizer method increased PaO2 (20%) and tidal volume transiently. If the patient needs bronchodilator inhalation with bronchospasm after OHS, the nebulizer method is the best choice. More study on the effects of bronchodilator inhalation in bronchospasm group is needed.
Subject(s)
Humans , Albuterol , Bronchial Spasm , Heart Rate , Heart , Hydrogen-Ion Concentration , Inhalation , Nebulizers and Vaporizers , Reference Values , Suction , Tidal Volume , Ultrasonics , Vital SignsABSTRACT
BACKGROUND: This study aimed at identifying the effects of improved methods of endotracheal suction and hand washing on incidence of nosocomial pneumonia (NP) in the neurosurgical ICU. METHOD: Repeated training of nurses about hand washing and adherence of the single use of suction catheter and sterile normal saline of endotracheal suction was provided. Then hand washing compliance of nurses before and after training was investigated. and the incidence of NP in all patients hospitalized for more than 72 hours in the neurosurgical ICU was investigated from Sep 1, 2000 to Jan 31, 2001 (2nd surveillance). The NP rate of that period was compared with the incidence of the 1st surveillance period, from Sep 1, 1999 to Jan 31, 2000. The data were analyzed with chi-square-test. Fisher's exact test and logistic regression analysis by SAS 8.0. RESULT: The proportion of hand washing performance increased from 15.6% to 46.8%. The rates of NP per patient during 1st surveillance and 2nd surveillance were 10.3%, 3.9%(p=0.01) patient-days rates of NP were 10.0 cases/1,000 patient days, 4.1 cases/1,000 patient days(p=0.04), and ventilator-days rates of NP were 67.6 cases/1.000 ventilator days, 16.2 cases/1,000 ventilator days(p=0.00) respectively. Out of 29 isolates, 18 were methicillin-resistant Staphylococcus aureus, which was the most frequently isolated microorganism. The risk factors associated with incidence of NP were age, length of stay, Glasgow coma scale, diabetes mellitus, duration of intubation, insertion of endotracheal tube, duration of tracheostomy, presence of tracheostomy, duration of ventilator, use of ventilator, and insertion of nasogastric tube. CONCLUSION: These results showed that single use of suction catheters and sterile normal saline and increased compliance of hand washing were important factors to decrease the incidence of NP.
Subject(s)
Humans , Catheters , Compliance , Diabetes Mellitus , Glasgow Coma Scale , Hand Disinfection , Hand , Incidence , Intensive Care Units , Critical Care , Intubation , Length of Stay , Logistic Models , Methicillin-Resistant Staphylococcus aureus , Pneumonia , Risk Factors , Suction , Tracheostomy , Ventilators, MechanicalABSTRACT
The purpose of this study was to survey the ability of nurses to perform endotracheal suction to provide basic data on correct endotracheal suction. The participants in this study were 181 intensive care unit nurses in two university hospitals and one general hospital located in Daegu, one university hospital and two general hospitals located in Pohang, one university hospital located in Gyeongju. These data were collected from February 1, 2001 to March 10, 2001 using self reported questionnaires.The study instrument, which was developed by these investigators, included questions on general characteristics and performance of endotracheal suction. The results of this study are as follows : 1.Of the participants 71.3% recognized correct endotracheal suctioning and 23.2% did not. 2.The greatest number, 57.5%, acquired knowledge about endotracheal suctioning at conferences on practice or education for staff. 3.There were significant differences in scores on performance of endotracheal suction according to department (F=2.60, P=.05) and hospitals (F=3.24, P=.01) among the general characteristics. 4. Slightly less than half of the participants, 47.8%, averaged correct scores for endotracheal suctioning procedures. Ventilator O2 supply had the highest score (84.0%), normal saline exchange time, the lowest (14.4%). From the results, we suggest that education is needed to increase the knowledge and correct performance of endotracheal suction. Further study including direct observation of performance of endotracheal suction is also needed.