Effects of two air-impact methods on clearing subglottic secretions in patients with tracheal intubation / 中华护理杂志

Objective To explore the effects of two methods of air-impact on clearing the subglottic secretion in patients with intubation.Methods A simple random sampling method was used to select 106 patients underwent mechanical ventilation through oral tracheal intubation in intensive medicine department from September 2016 to October 2017.The recruited patients were divided into two groups by the random number table,53 patients in Group A were treated with breath-holding key of a ventilator,combined with air-bag inflation and deflation,and 53 patients in Group B were treated with simple breathing apparatus combined with manual technique to clear subglottic secretion.The incidence of ventilator-associated pneumonia(VAP),amount of cleared subglottic secretions,difference of vital signs before and after operation,number of coughing,in vitro training time and operation time were compared between groups.Results The intention-to-treat ana]ysis(ITT) showed that the incidence of VAP in Group A and B were 7.55％ and 5.66％,the per-protocol analysis(PP) showed that the incidence of VAP in Group A and B were 3.92％ and 3.85％,and there was no significant difference between groups(P＞0.05);the amount of cleared subglottic secretions in two groups were (8.31±0.82) ml,(7.97±1.12)ml,and there was no significant difference (P＞ 0.05);but vital signs before and after operation,number of coughing,in vitro training time and operation time in Group A were lower than those in Group B,and the differences were statistically significant(P＜0.05).Conclusion Two methods of air-impact can both effectively reduce the incidence of VAP,but using breath-holding key of a ventilator combined with airbag inflation and deflation has less influence on vital signs,which patients can better tolerate and medical staff can master and cooperate more easily.

Assessment of the effectiveness of a ventilator associated pneumonia prevention bundle that contains endotracheal tube with subglottic drainage and cuff pressure monitorization

ABSTRACT The effectiveness of prevention bundles on the occurrence and mortality of ventilator associated pneumonia (VAP) was evaluated in many studies. However, the effectiveness of endotracheal tube with subglottic secretion drainage (ETT-SD) and cuff pressure monitorization in VAP bundles have not been adequately assessed. In this study, we aimed to evaluate the effectiveness of VAP bundle containing ETT-SD and cuff pressure monitorization. This was a prospective, controlled study that was carried out between March 2011 and April 2012 including intubated patients. The study was conducted at the Anesthesiology Intensive Care Unit 1 and 2 (10 beds each) in a 898-bed university hospital. Occurrence of VAP and compliance with the parameters of the VAP prevention bundles were assessed daily. Patients intubated with the standard endotracheal tube were recruited as controls, mainly in the first six months of the study as ETT-SD and cuff pressure monometer had not yet been implemented. In the second term, patients intubated with ETT-SD were included as cases. Occurrence of VAP, mortality, and compliance with VAP prevention bundles were monitored. A total of 133 patients, 37 cases and 96 controls were recruited. VAP incidence declined from 40.82 to 22.16 per 1000 ventilator days among controls and cases, respectively (p < 005). On average, VAP occurred 17.33 ± 21.09 days in the case group and 10.43 ± 7.83 days in the control group (p = 0.04). However, mortality of cases and controls at the 14th and 30th days was not different. VAP prevention bundles including the utilization of ETT-SD, monitoring cuff pressure, and oral care with chlorhexidine were efficient in reducing the rate of VAP.

Effects of subglottic secretion drainage at different intervals on ventilator-associated pneumonia / 中国实用护理杂志

Objective To investigate the effects of subglottic secretion drainage at different intervals on ventilator- associated pneumonia(VAP). Methods A total of 150 patients receiving tracheostomy during January 2015 to December 2016 were divided into A, B, C group according to the order of intubation time. The subglottic secretion drainage was attracted at intervals of 2, 4, and 6 h respectively.The differences in balloon secretion on occult blood test(after intubation,intubation time,3 d, 5 d,7 d), the content of airborne bacteria in the air sac, the number of VAP and the time of VAP occurrence between the 3 groups were analyzed. Results The 3 groups that group A had 78 positive cases,group B had 46 cases and group C had 38 cases had statistical significance differences compared with balloon retentate occult blood test(χ2=28.23,P=0.00);there were statistical significance differences between the 3 groups of bacteria (Z=11.91, P =0.00 ), there were statistically significant differences between group A and group C (Z=-3.01, P=0.00), between group B and group C (Z=-2.19, P=0.01). There were statistical significance differences between the 3 groups of the number of VAP cases(χ2=7.50, P =0.00) that there were 12 cases happening in group A, 13 cases in group B and 23 cases in group C. There were statistical significance differences between group A and group C(χ2=5.32,P=0.02),between group B and group C (χ2=4.34, P =0.04). The occurrence time of VAP which was (169.25 ± 20.80) h in group A,(168.35±18.04)h in group B and(129.47±18.13)h in group C,there was significantly different between the 3 groups(F=2 788.19,P=0.00),the differences between group A and group C(t=3.19,P=0.00),group B and group C(t=68.40,P=0.00)were statistically significant. Conclusions The subglottic secretion drainage at intervals of 4 hours will not only reduce the damage to the airway mucosa,but also reduce the incidence of airway bacteria and the incidence of VAP and delay the occurrence of late VAP.

Comprehensive effect of subglottic secretion drainage on patients with mechanical ventilation in ICU:a Meta-analysis / 中华危重病急救医学

Objective To systematically evaluate the comprehensive effect of subglottic secretion drainage (SSD) on patients with mechanical ventilation (MV) in intensive care unit (ICU). Methods The randomized controlled clinical trials (RCTs) comparing SSD (intervention group) versus non-SSD (control group) in adult patients with MV in ICU was collected through the databases such as the PubMed database of the National Library of Medicine, CNKI, Wanfang database and the Chinese journal of science and technology database (VIP). The subjects were ICU patients with MV, and the retrieval time ranged from January 2006 to December 2016. Two reviewers independently screened the studies according to the inclusive and exclusive criteria, extracted the data, and assessed the quality. Then RevMan 5.3 software was used for Meta-analysis. Sensitivity analysis was performed using Stata 11.0 software. Funnel plot was used to analyze publication bias. Results In the 1004 documents obtained from preliminary screening, a total of 13 studies involving 2052 patients were enrolled after excluding duplicated documents and literature did not meet the inclusion criteria, with 1021 patients in intervention group, and 1031 in control group. Meta-analysis showed that compared with control group, the application of SSD in patients with MV could contribute to the reduction of the incidence of ventilator-associated pneumonia [VAP; risk ratio (RR) = 0.54, 95% confidence interval (95% CI) = 0.46-0.64, P < 0.00001], the duration of MV [mean difference (MD) = -3.29, 95%CI = -4.53 to -2.05, P < 0.00001] and length of hospital stay (MD = -4.27, 95% CI = -7.36 to -1.18, P = 0.007) were shortened, while there was no significant difference in ICU or hospital mortality rate between the intervention group and control group (RR = 0.89, 95%CI = 0.73-1.09, P = 0.25). The sensitivity analysis for studies enrolled in Meta-analysis of MV duration showed that individual research results were stable through step remove of the included literatures and combined calculation of the remaining literature value, suggesting that individual research results were stable, and would not have a significant impact on the overall results. The results of the funnel analysis showed that there was a symmetry in the inclusion studies, and no significant publication bias was found. Conclusions SSD did have effect in reducing the incidence of VAP, shortening the duration of MV and length of hospital stay, while there was no significant effect on reducing mortality rate. Effective use of SSD is an important measure to prevent VAP. It is necessary to objectively evaluate the clinical effect of SSD.

The effect of oral care on the prevention of ventilator associated pneumonia in patients with severe traumatic brain injury by aspiration of subglottic secretion combined with 2%acetic acid chloride solution / 中国实用护理杂志

Objective To explore the effect of oral care on the prevention of ventilator associated pneumonia in patients with severe traumatic brain injury by aspiration of subglottic secretion combined with 2% acetic acid chloride solution. Methods A total of 100 cases of ICU patients with mechanical ventilation for longer than 48 hours were divided into group B and group C using a random number table method according to tracheotomy mechanical ventilation time sequence number from January 2014 to June 2015. Another 50 ICU patients in group A (as the case for retrospective analysis, from April to November , 2013) were treated by routine tracheal suction, normal saline cotton for oral care, group B were treated with aspiration of subglottic secretion, normal saline cotton for oral care, group C were treated with aspiration of subglottic secretion combined with 2% acetic acid chloride solution for oral cleaning. And then VAP occurrence rate, plaque index, plaque clearance were evaluated. Results The incidence rates of early onset VAP in three groups were 14% (7/50), 8% (4/50), 4% (2/50), and incidence rates of late onset VAP were 22% (11/50),12% (6/50), 8% (4/50) respectively, the differences were significant (χ2=3.65, 3.88,P<0.01). The plaque index and plaque clearance rates of the three groups on the third day were 2.14± 0.35, (40.12 ± 13.11)%, 2.10 ± 0.33, (39.17 ± 14.21)%, 1.03 ± 0.24, (60.12 ± 15.07 )%(F=12.21,χ2=3.82,P<0.01);while on the 7th day, they were 1.76 ± 0.47, (41.12 ± 13.34)%, 1.80 ± 0.32, (39.37 ± 12.21)%, 0.99 ± 0.15, (60.33 ± 14.25)%(F=13.14,χ2=4.20,P<0.01). Conclusions The incidence rate of VAP can be decreased by the combination of aspiration of subglottic secretion and oral cleaning with 2%acetic acid chloride solution.

Application of choosing negative pressure by different sticky secretion different sticky secretion in continuous aspiration of subglottic secretion with mechanical ventilation / 现代临床护理

Objective To explore the effect of continuous aspiration of subglottic secretion at different negative pressure levels on mechanical ventilation. Methods Toally 142 patients were randomized by way of lottery into the control group (n=70) and the experiment group ( n = 72 ): the control group received continuous negative pressure aspiration of subglottic secretion at a negative pressure of 60 mmHg while the experiment group did 30~40 mmHg for grade I of the sticky secretion , 40~60 mmHg for gradeⅡ~Ⅲof the sticky secretion, respectively. The two groups were compared in terms of the rate of ventilator associated pneumonia (VAP), airway mucosal injury and cough. Result There was no significant difference in the rate of ventilator associated pneumonia (P>0.05), but the rates of airway mucosal injury and cough were lower in the experiment group than those of the control group (P < 0.05). Conclusion It is reasonable to choose different negative pressure levels based on stickiness of the secretions for mechanical ventilation, for it can prevent the ventilator associated pneumonia and airway mucosal injury.

Effect evaluation of preventing ventilator associated pneumoia of patients with the oral trachea can-nula by air impact method to remove airbags retentate / 中国实用护理杂志

Objective To evaluate effect of preventing ventilator associated pneumoia (VAP) of patients with oral cavity endotracheal intubation by air impulse clearing away secretion drainage. Methods 348 patients with oral trachea cannula and mechanical ventilation (MV) in intensive care unit (ICU) were divided into control group (n=174) and observational group (n=174). The control group adopted conventional airway management methods without the subglottic secretion drainage while the observational group adopted conventional airway management methods on the basis of combining air impact method remove stranded on airbags. Other treatment and care for all of patients were basically the same. The MV time, duration in ICU and incident rate on VAP were compared between the two groups. Results The average of MV time in control group was (5.25±1.18) days, (5.62±3.20) days in ICU and the rate of VAP was 10.34%(18/174). In observational, it was (8.96 ±5.43) days, (10.43 ±4.96 ) days and 34.48%(60/174), respectively. The MV time, duration in ICU and incident rate on VAP were significantly different (P<0.05), with statistical significance. Conclusions The air impact method to remove airbags retentate could shorten time of MV and during time in ICU, and could reduce the rate of VAP.

Meta- analysis of effects of intermittent subglottic secretion drainage on ventilator- associated pneumonia / 中国实用护理杂志

ObjectiveTo study the effects of intermittent subglottic secretion drainage(SSD)with an endotracheal tube on incidience of ventilator- associated pneumonia(VAP). MethodsWe searched computerized databases,including Cochrane library,Pubmed,EMbase,CBM,CNKI,Wanfang and some relevant databases from initializing to March 2012,extracting data about subglottic secretion drainage(SSD)with an endotracheal tube on incidence of VAP using RCT.The data had Meta- analysis by software RevMan5,and to those data which could not be conversed or merged,they underwent descriptive analysis. ResultsWeidentifled 5 randomized clinical trials that met the inclusion criteria with a total of 683 randomized patients.In Meta- analysis,the overall risk ratio for ventilator- associated pneumonia was decreased significantly by intermittent subglottic secretion drainage with an endotracheal tube.There was no significant difference on adverse events or on hospital or intensive care unit mortality.Databases,including ICU and hospital LOS,duration of endotracheal catheterization,bacteria concentration,which were difficult to be conversed and obtained full data,they underwent a descriptive research. ConclusionsCompared with the common endotracheal tubes,the use of endotracheal tubes with subglottic secretion drainage is effective for prevention of ventilatorassociated pneumonia.But it has no effect on adverse events or on hospital or intensive care unit mortality.So large sample RCTs with multiply- center should be carried out to assess the effect of the use of SSD.

Subglottic secretion drainage for preventing ventilator-associated pneumonia: a Meta-analysis / 中华急诊医学杂志

ObjectiveTo assess the efficacy of subglottic secretion drainage for preventing ventilatorassociated pneumonia.MethodsData of relevant randomized controlled trials (RCT) from January 1991 to June 2010 were collected,and data were split into two groups,namely draining group and non-draining group.Meta analysis of ventilator-associated pneumonia was carried out for finding the incidence and mortality in patients with mechanical ventilation using the methods recommended by the Cochrane Collaboration.ResultsSeven RCTs met the inclusion criteria and 1647 patients were enrolled.Subglottic secretion drainage reduced the incidence of ventilator-associated pneumonia ( OR =0.45,95％ confidence interval [CI]:0.32 - 0.63 ),primarily by reducing early-onset pneumonia.But the mortalities of ventilator associated pneumonia were not significantly different between the two groups ( OR =1.03,95％ confi dence interval [CI]:0.75 - 1.41 ).ConclusionsSubglottic secretion drainage appeared effective in preventing ventilator associated pneumonia among patients expected to require ＞48 hours of mechanical ventilation,but the mortality was unchanged.

Effect of subglottic secretion drainage on the prevention of ventilator associated pneumonia / 中国实用护理杂志

Objective To assess the influence of subglottic secretion drainage(SSD)on the prevention of ventilator associated pneumonia(VAP).Methods 63 patients in the intensive care unit(ICU)who received mechanical ventilation above 48 hours were divided into two groups named group A(31 cases)and group B(32 cases).Group A received SSD 1 time per 6 hours while group B only got SSD at 48 hours,the 4th,7th and 14th days when samples were got.We brushed away secretion from airway and also monitored bacteriology of the subglottic secretion between the two groups. Results The incidence rate of VAP in group A was 6.1%and was evidently lower than that of group B(P<0.05),which was 31.3%within 1 week.But 1 week later the incidence rate of VAP in the two groups was not statistically difierent(P>0.05).The onset time of VAP was later anti the bacteria number in the subglottic secretion was less in group A than those in group B(P<0.01).The same bacteria strain was found in the subglottic secretion and airway secretions in 13 patients out of 22 VAP patients.The dominant bacteria were P.aeruginosa,K.pneumonia,Staphylococcus aureus and Pseudomonas stenotrophomonas. Conclusion SSD could reduce the bacteria concentration in subglottic secretion,decrease VAP incidence and delay the onset of VAP.Migration of dominant bacteria from the subglottic secretion was one of the important causes of VAP.

Effects of subglottic secretion drainage on pulmonary infection in severe craniocerebral injury / 中国医师进修杂志

Objective To discuss the clinical value of subglottic secretion drainage on pulmonary infection in severe craniocerebral injuried patients. Methods Eighty severe craniocerebral injuried patients in ICU with the requirement of tracheotomy were randomized into two groups. Forty patients received aspiration of subglottic secretions as the treatment group and the other 40 patients received usual care as control. Samples were taken from pharynx mop, subglottic secretion and lower respiratory tract secretion for bacterial culture at 48 hours, 7th day and 14th day past tracheotomy. Results The incidence of pulmonary infection was 22.5% in treatment group and 45.0% in control. The same rate of predominant flora in subglottic secretion and lower respiratory tract secretion was 63.0% in patients with pulmonary infection. Conclusions Transposition of the pathologic bacteria in the subglottic secretion is one of the important causes of pulmonary infection, subglottic secretion drainage can lower the incidence of pulmonary infection in severe craniocerebral injuried patients.

Pathogenic Bacteria Isolated from Subglottic Secretion in 43 Cases with Ventilator-associated Pneumonia: Their Distribution and Drug Resistance / 中华医院感染学杂志

0.05). CONCLUSIONS The pathogenic bacteria from VAP subglottic secretion are mostly Gram-negative rods, in which the dominant bacteria are A. baumannii, P. aeruginosa, S. maltophilia, K. pneumoniae and Escherichia coli. Most of them are multi-drug resistant. The kinds of pathogenic bacterial strains in subglottic secretion and lower respiratory tract secretion are not only consistent but also similar to each other in terms of composition and drug resistance.