ObjectiveTo systematically review the efficacy of closed and open tracheal suction system on the prevention of ventilator-associated pneumonia.MethodsThe Cochrane Library, CNKI, WanFang Data, Airiti Library, PubMed, CINAHL and Proquest databases were electronically searched to collect randomized controlled trials (RCTs) on closed and open tracheal suction system on the prevention of ventilator-associated pneumonia. Two reviewers independently screened literature, extracted data, and assessed the risk bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 11 RCTs involving 1 187 patients were included. The results of meta-analysis showed that compared with open tracheal suction system, closed tracheal suction system was associated with a reduced incidence of ventilator-associated pneumonia (RR=0.55, 95%CI 0.44 to 0.67, P<0.000 01), late-onset ventilator-associated pneumonia (RR=0.47, 95%CI 0.28 to 0.80, P=0.005), length of stay in intensive care unit (MD=?0.85, 95%CI ?1.66 to ?0.04, P=0.04) and rate of microbial colonization (RR=0.69, 95%CI 0.56 to 0.86, P=0.000 9). However, there were no significant differences between two groups in time to ventilator-associated pneumonia development (MD=0.96, 95%CI ?0.21 to 2.12, P=0.11), length of mechanical ventilation (MD=?2.24, 95%CI ?4.54 to 0.06, P=0.06), and rate of mortality (RR=0.88, 95%CI 0.73 to 1.05, P=0.15).ConclusionsCurrent evidence shows that compared with open tracheal suction system, closed tracheal suction system can reduce the incidence of ventilator-associated pneumonia and late-onset ventilator-associated pneumonia, shorten the hospital stay in intensive care unit, and reduce rate of microbial colonization. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo investigate the prognostic value of high mobility group protein 1 (HMGB1) in patients with ventilator-associated pneumonia (VAP).
MethodsA total 118 VAP patients admitted between March 2013 and March 2015 were recruited in the study. The patients were divided into a death group and a survival group according to 28-day death. Baseline data, HMGB1, C-reactive protein (CRP), clinical pulmonary infection score (CPIS), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and sepsis-related organ failure assessment (SOFA) scores were collected on 1st day (d1), 4th day (d4), and 7th day (d7) after VAP diagnosis. The possible prognostic factors were analyzed by univariate and logistic multivariate analysis.
ResultsThere were 87 cases in the survival group and 31 cases in the death group. Age, female proportion, body mass index, HMGB1 (d1, d4, d7), APACHEⅡ (d1, d4, d7) and SOFA (d1, d4, d7) scores were all higher in the death group than those in the survival group (all P < 0.05). HMGB1 (d4, P=0.031), APACHEⅡ (d4, P=0.018), SOFA (d4, P=0.048), HMGB1(d7, P=0.087), APACHEⅡ(d7, P=0.073) and SOFA (d7, P=0.049) were closely correlated with 28-day mortality caused by VAP. Multivariate analysis revealed that HMGB1 (d4, HR=1.43, 95%CI 1.07 to 1.78, P=0.021), SOFA (d4, HR=1.15, 95%CI 1.06 to 1.21, P=0.019) and HMGB1 (d7, HR=1.27, 95%CI 1.18 to 1.40, P=0.003) were independent predictors of death in the VAP patients. ROC curve revealed HMGB1 (d4, d7) and SOFA (d4) with area under ROC curve of 0.951, 0.867 and 0.699.
ConclusionIndividual HMGB1 level can be used as a good predictor of the short-outcomes of VAP.
Objective
To formulate an evidence-based position program for a ventilation patient with acute respiratory distress syndrome (ARDS).
Methods
Based on fully assessing the patient’s conditions, the clinical problems were put forward according to PICO principles. Such database as The Cochrane Library (2005 to January 2011), DARE (March 2011), CCTR (March 2011), MEDLINE (1996 to January 2011) and CNKI (1979 to January 2011) were retrieved to collect high quality clinical evidence, and then the optimum nursing program was designed in line with patient’s conditions and relatives’ willingness.
Results
Three meta-analyses, three randomized controlled trials, one systematic review and one anterior-posterior self-control study were included. The available clinical evidence displayed that: a) the prone position adopting earlier, especially for patients with bilateral lungs or left lung functional disorder, was propitious to effectively improve the oxygenation condition and reduce the incidence of ventilator induced lung injury (VILI); b) The long-term prone position could increase the risk of pressure sore; c) The prone position could prolong the survival time, but there was no enough evidence to prove that it could obviously decrease the mortality rate of ARDS. So finally a nursing plan was made in combination with literature evidence and patient’s condition: adopting the prone position after onset within 24 to 36 hours, and enhancing the skin nursing to prevent pressure sore at the same time. After 4-week comprehensive therapy and prone position ventilation, the patient got obvious alleviated in oxygenation, with SpO 2 up to 90% to 100%, stable vital signs, and no more VILI and pressure sore. And then the patient was stopped applying ventilator, and transferred to a general ward for further treatment. Conclusion The earlier adoption of prone position ventilation for severe ARDS can improve oxygenation and reduce ventilator associated pneumonia (VAP) and VILI, but whether it can prolong survival time and reduce mortality for mild ARDS or not still has to be proved with more high quality evidence in the future.
ObjectiveTo investigate the clinical value of serum proadrenomedullin (pro-ADM) for diagnosis of ventilator-associated pneumonia(VAP).
MethodsA prospective study was carried out in eighty-nine patients with clinically suspected diagnosis of VAP who underwent invasive mechanical ventilation between June 2014 and July 2015.The patients were divided into a VAP group (n=52) and a non-VAP group (n=37) according to clinical and microbiological culture results.The levels of serum pro-ADM were measured by sandwich ELISA on 1st, 3rd and 5th day of VAP suspicion.The diagnostic value of pro-ADM for VAP was assessed by receiver operating characteristic (ROC) curve analysis.
ResultsOn 1st day, 3rd day and 5th day, the pro-ADM levels [3.10(2.21, 4.61) nmol/L, 3.01(2.04, 4.75)nmol/L and 1.85(1.12, 3.54)nmol/L, respectively] in the VAP group were significantly higher than those in the non-VAP group [1.53(1.07, 2.24)nmol/L, 1.52(1.05, 2.17) nmol/L and 1.26(1.02, 2.17) nmol/L, respectively] (all P < 0.05).For diagnosis of VAP, the area under the ROC curve (AUC) for pro-ADM on 1st, 3rd and 5th were 0.896 (95%CI 0.799-0.940), 0.863(95%CI 0.791-0.935) and 0.651 (95%CI 0.538-0.765), respectively.When using 2.53 nmol/L as the best cutoff on 1st day, pro-ADM had 84.6% sensitivity and 86.5% specificity.When using 2.40 nmol/L as the best cutoff on 3rd day, pro-ADM had 82.7% sensitivity and 83.8% specificity.
ConclusionSerum level of pro-ADM in the diagnosis of VAP has good sensitivity and specificity, which may be used as a marker to diagnose VAP early.
Objective To analysis the risk factors for lower airway bacteria colonization and ventilator-associated pneumonia ( VAP) in mechanically ventilated patients. Methods A prospective observational cohort study was conducted in intensive care unit. 78 adult inpatients who underwent mechanical ventilation( MV) through oral endotracheal intubation between June 2007 and May 2010 were recruited. Samples were obtained from tracheobronchial tree immediately after admission to ICU and endotracheal intubation( ETI) , and afterward twice weekly. The patients were divided naturally into three groups according to airway bacterial colonization. Their baseline characteristics, APACHEⅡ score, intubation status and therapeutic interventions, etc. were recorded and analyzed. Results In the total 78 ventilated patients, the incidence of lower airway colonization and VAP was 83. 3% and 23. 1% , respectively. The plasma albumin( ALB) ≤29. 6 g/L( P lt; 0. 05) , intubation attempts gt; 1( P lt; 0. 01) were risk factors for lower airway colonization. In the patients with lower airway colonization, preventive antibiotic treatment, applying glucocorticoid and prealbumin( PA) ≤ 69. 7 mg/L were risk factors for VAP ( P lt; 0. 05) . Conclusions The risk factors for lower airway colonization in ventilated patients were ALB≤29. 6 g/L and intubation attempts gt; 1. And for lower airway colonized patients, PA ≤ 69. 7 mg/L, preventive antibiotic treatment and applying glucocorticoid were risk factors for VAP.
Objective To explore the effectiveness and safety of self-made washable endotracheal tube for subglottic secretion drainage. Methods Ordinary endotracheal tube and sputum aspirating tubes were used to make washable endotracheal tube for subglottic secretion drainage in our hospital. The self-made tubes were compared with washable endotracheal tube available on the market. The suction resistance, the cases of obstruction in the tubes, the average daily drainage, and the cases of infection of incisional wound were compared between the two kinds of tubes, and their safety was evaluated. Results After three days of application, the suction resistance of endotracheal tube available on the market increased, with six cases of the blockage of the lumen ( 85% ) , while that of self-made endotracheal tube did not change, with no cases of blockage ( 0% ) . There was significant difference between these two kinds of tubes ( P lt;0. 01) . The average daily drainage in the former was ( 16. 55 ±8. 66) mL/d; while that in the latter was ( 40. 12 ±25. 48) mL/d. There was no significant statistical difference between the two kinds of tubes ( P gt;0. 05) . The incidence ofinfection of incisional wound in the ordinary endotracheal tube was 50% ( 5 cases) ; that in the tubes available on the market was 28% ( 2 cases) ; that in the self-made tubes was 15% ( 2 cases) . There was significant difference among the three groups. When tube cuffs were inflated, the distance between the back edge of suction tubes and tube cuffs was was 2-4 mm. Conclusion Self-made washable endotracheal tubes are effective for subglottic secretion drainage with good safety and low price.
ObjectiveTo investigate the incidence of nosocomial infection and device-related infection in the Intensive Care Unit (ICU), analyze its related risk factors, and search for effective measures to prevent and control nosocomial infection.
MethodsBy prospective objective monitoring method, we surveyed 294 patients hospitalized in the ICU for at least 48 hours between January and December 2012. The doctor in charge filled in relevant information of the patients to complete the questionnaires, and hospital infection management staff was responsible for tracking, judging, and statistical analysis.
ResultsIn the 294 patients, 61 had hospital infections, and there were 78 cases. The hospital infection rate was 20.75%, and the case infection rate was 26.53%. The day incidence of patient infection was 16.01‰, and day infection rate was 20.47‰ for infection cases. After average severity of illness score adjustment, the day case infection rate was 7.48%, ventilator associated pneumonia (VAP) infection rate was 27.27‰, central venous catheter associated bloodstream infection rate was 6.58‰, and catheter associated urinary tract infection rate was 3.15‰.
ConclusionICU has a high risk of hospital infection. In the device related infections, VAP infection rate is the highest. Continuous improvement can be achieved through monitoring and discovering problems, strengthening hospital infection management training for the medical personnel of the hospital, close communication between doctors and hospital infection management staff, and strict implementation of hospital infection management measures.
【Abstract】 Objective To analyze the risk factors for ventilator-associated pneumonia ( VAP) in respiratory intensive care unit ( RICU) , as well as the impact on mortality. Methods A retrospective cohort study was conducted in 105 patients who had received mechanical ventilation in RICUbetweenMay 2008 andJanuary 2010. The duration of intubation, vital signs, primary disease of respiratory failure and complications,blood biochemistry, blood routine tests, arterial blood gas analysis, APACHEⅡ score,medications, nutritional status, bronchoalveolar lavage ( BAL) , protected specimen brush ( PSB) quantitative culture, chest X-rayexamination were recorded and analyzed. Results The incidence rate of VAP was 32. 4% . Mortality in the VAP patients were significantly higher than those without VAP( 58. 8% vs. 28. 2% , P = 0. 007) . The duration of intubation, hypotension induced by intubation, cerebrovascular disease, and hypoalbuminemiawererisk factors for VAP in RICU. Conclusions Mortality of the patients with VAP increased obviously. The risk factors for VAP in RICU were the duration of intubation, hypotension after intubation, cerebrovascular disease, and hypoalbuminemia.
