Nosocomial pneumonia in mechanically ventilated patients, a prospective randomised evaluation of the Stericath closed suctioning system
Nosocomial pneumonia in mechanically ventilated patients, a prospective randomised evaluation of the Stericath closed suctioning system
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DOI：
10.1007/s001340051276
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发表时间：
2000-07-01
影响因子：
38.9
通讯作者：
Oleyer, C
中科院分区：
文献类型：
--
作者：
Combes, P;Fauvage, B;Oleyer, C
目的：根据气管内吸痰类型（封闭式与开放式）比较机械通气患者的呼吸机相关性肺炎（VAP）发生率。单位：法国格勒诺布尔大学医院神经外科重症监护室。设计：一项前瞻性随机研究，经过6个月的护理人员培训。患者：104例需要机械通气超过48小时的连续患者随机分为两组。要符合条件，患者必须在其通行证中没有活动性感染或呼吸道感染。在Stericath组（S + n = 54）中，患者在抽吸期间未与呼吸机断开连接。其余患者均常规治疗（S-，n = 50）。在两组中，根据标准化方案进行抽吸频率和持续时间的模式。测量：S +组VAP的未校正发生率低于S-组（7.32 vs 15.89/1000患者-天，p = 0.07）。使用考克斯模型进行的多变量分析显示，S-组VAP的校正风险高3.5倍（95% CI：11.00-12.33）。接受胃酸分泌抑制剂的患者的风险高出4.3（1.08-16.82）。在非删失病例（n = 76）中，当存在VAP时，ICU住院时间平均增加16.8天（p = 0.0008）。未观察到Stericath使用引起的不良反应，两组的气管抽吸物体积相似（p = 0.178）。结论：Stericath的使用降低了VAP的发生率，未显示任何不良反应。
Objective: To compare the ventilator-associated pneumonia (VAP) incidence rates in mechanically ventilated patients according to the type of endotracheal suctioning (closed versus open). Setting: The Neurosurgery Intensive Care Unit of the Grenoble University Hospital, France. Design: A prospective randomised study performed after a 6-month period of nursing personnel training. Patients: One hundred four consecutive patients needing mechanical ventilation for more than 48 h were randomised into two groups. To be eligible, patients had to have no active infection or respiratory affection in their passes. In the Stericath group (S + n = 54), patients were not; disconnected from the ventilator during suctioning. The others were routinely managed (S-, n = 50). In both groups patterns of frequency and duration of suctioning were performed according to a standardised protocol. Measurements: The non-adjusted incidence rate of VAP was lower for S + than for S- (7.32 versus15.89 per 1000 patient-days, p = 0.07). Multivariate analysis performed using the Cox model showed an adjusted risk of VAP 3.5 times higher in S- (95 % Cl: 11.00-12.33). The risk being 4.3 higher in patients receiving gastric acid secretion inhibitors (1.08-16.82). In non-censored cases (n = 76) length of ICU stay increased by an average of 16.8 days when VAP was present (p = 0.0008). No adverse effect due to Stericath use was noted and volume of tracheal aspirate was similar between groups (p = 0.178). Conclusion: The use of Stericath reduced the incidence rate of VAP without demonstrating any adverse effect.