Effect of the improved continuous subglottic approach in patients with mechanical ventilation / 中国实用护理杂志

Objective To investigate the clinical effect of the improved continuous subglottic approach in patients with mechanical ventilation. Methods A total of 90 ICU patients with mechanical ventilation , were divided into observation group and control group 1 and control group 2 by random digits table method,each group was 30 cases.The observation group used the improved continuous subglottic suction. The control group 1 used the way of continuous 24 h suction under glottis. The control group 2 used the way of every 2 h suction under glottis combined with subglottic. The incidence of ventilator-associated pneumonia (VAP), the rate of tube blockage, the amount of subglottic secretion and the damage of airway mucosa were observed. Results The incidence of 7 d VAP in the observation group was 3.33％(1/30), which was not significantly different from that in the control group 1 and the control group 2 (P>0.05), but it was lower than the incidence of VAP at home and abroad. The rate of plugging in the observation group was 6.67％(2/30), and that in the control group 1 was 23.33％(7/30), and the difference was statistically significant (χ2=4.320, P<0.05). The daily flow rate of subglottic secretion was (30.93 ± 8.01) ml/d in the observation group, and (19.75 ± 6.52) ml/d in the control group 2, the difference was statistically significant (t=7.542, P<0.05). The injury rate of airway mucosa in the observation group was 10.00％(3/30), and 33.33％(10/30) in the control group 1, the difference was statistically significant (χ2=4.812, P<0.05). Conclusions The improvement suction under glottis method can be widely applied in clinical practice,which can effectively reduce the incidence of VAP, subglottic tube plugging rate, fully drainage of subglottic secretions, the degree of airway mucosa damage, reduce nursing workload compared with intermittent subglottic.

Impacto da aspiração supra-cuff na prevenção da pneumonia associada à ventilação mecânica / Impact of supra-cuff suction on ventilator-associated pneumonia prevention

O paciente crítico encontra-se intubado ou traqueostomizado por necessitar, na maioria dos casos, de ventilação mecânica invasiva. As cânulas utilizadas possuem o cuff, que pode atuar como um reservatório de secreções da orofaringe, predispondo à pneumonia associada à ventilação mecânica. Estudos têm demonstrado que a aspiração das secreções subglóticas por lúmen dorsal de sucção acima do cuff do tubo orotraqueal retarda e reduz a incidência de pneumonia associada à ventilação mecânica. O objetivo desta revisão foi verificar, na literatura, a importância da utilização da aspiração com dispositivo supra-cuff em pacientes críticos submetidos à intubação orotraqueal ou traqueostomia na prevenção de pneumonia associada à ventilação mecânica. Para tanto, foi realizada revisão bibliográfica entre os anos de 1986 a 2011, por meio de portais de bases de dados nacionais e internacionais. Verificou-se que a aspiração das secreções subglóticas apresenta poucos resultados em relação à diminuição dos dias de ventilação mecânica e de permanência na unidade de terapia intensiva, além de não ser efetiva na diminuição da mortalidade, porém, mostra-se eficaz na redução da incidência da pneumonia associada à ventilação mecânica de início precoce e na redução de seus custos hospitalares. A forma de aspiração das secreções subglóticas contínua mostra-se mais eficiente na remoção de secreções; contudo, a forma intermitente parece ser a menos lesiva. Conclui-se que as cânulas com dispositivo de aspiração supra-cuff permitem a aspiração das secreções subglóticas, proporcionando benefícios aos pacientes críticos, uma vez que reduzem-se a incidência de pneumonia associada à ventilação mecânica e, consequentemente, os custos hospitalares, além de não haver relação com efeitos adversos em larga escala.

Critically ill patients are intubated or tracheostomized because, in most cases, these individuals require invasive mechanical ventilation. The cannulae that are used include the cuff, which can act as a reservoir for oropharyngeal secretions, predisposing to ventilator-associated pneumonia. Studies have revealed that the suction of subglottic secretions through the dorsal suction lumen above the endotracheal tube cuff delays the onset and reduces the incidence of ventilator-associated pneumonia. The aim of this review is to assess published studies regarding the significance of using suction with a supra-cuff device for the prevention of ventilator-associated pneumonia in critically ill patients treated with orotracheal intubation or tracheostomy. Therefore, by searching national and international databases, a literature review was undertaken of studies published between the years 1986 and 2011. Few results were found relating the suction of subglottic secretions to decreased duration of mechanical ventilation and length of stay in the intensive care unit. The suction of subglottic secretions is ineffective in decreasing mortality but is effective in reducing the incidence of early-onset ventilator-associated pneumonia and hospital costs. Techniques involving continuous suction of subglottic secretions may be particularly efficient in removing secretions; however, intermittent suction appears to be the least harmful method. In conclusion, cannulae with a supra-cuff suction device enable the aspiration of subglottic secretions, providing benefits to critically ill patients by reducing the incidence of ventilator-associated pneumonia and, consequently, hospital costs - with no large-scale adverse effects.

Clinical Utility of Swallowing Provocation Test and Water Swallowing Test in Stroke Patients

OBJECTIVE: To assess the clinical utility of the swallowing provocation test (SPT) and water swallowing test (WST) as a predictive factor of supraglottic penetration (SP) and subglottic aspiration (SA) in stroke patient with dysphagia. METHOD: Fourty-one patients suffered from ischemic stroke with dysphagia and 20 normal controls were recruited. We performed 2-step SPT (0.4 ml, 2.0 ml) via nasopharyngeal tube and 2-step WST (10 ml, 30 ml) per oral, combined with the videofluoroscopic swallowing study (VFSS) to determine the presence of SP and SA. RESULTS: The cutoff values of the swallowing provocation latency in SPT for the detection of SP and SA were 2.45 sec, 2.75 sec (first step) and 2.25 sec, 2.34 sec (second step). For SPT, the sensitivity and specificity were 78.8%, 64.3% (first step) and 71.4%, 77.8% (second step) for the SP, and 77.8%, 76.7% (first step) and 75.0%, 66.7% (second step) for the SA. For WST, the sensitivity and specificity were 66.7%, 90.9% (first step) and 70.0%, 90.9% (second step) for the SP, and 61.1%, 56.5% (first step) and 72.2%, 60.9% (second step) for the SA. CONCLUSION: SPT was more useful for the detection of SA than WST in stroke patient with dysphagia.