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

ABSTRACT

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.