BACKREST POSITION AND ORAL HEALTH--EFFECT ON VAP

描述（改编自研究者摘要）：肺炎是 医院感染是导致死亡的主要原因， 美国的医院感染。 插管和机械通气 大大增加细菌性呼吸机相关性肺炎的风险 （VAP）。 ICU中的患者特别脆弱，因为普通ICU 插管和机械通气的程序大大增加了 细菌性VAP的风险。 此外，仰卧位，经常使用 ICU护士管理与血流动力学不稳定相关的问题 进一步增加了VAP的风险。 尽管疾病中心 控制和预防建议使用较高的靠背位置（30-45 度），明确的科学研究 但还没有为支持这一建议而采取行动。 除了有 仰卧位时，口咽部的细菌定植也是一种 VAP的重要危险因素。 机械工人口腔健康状况 通气的患者可能受到患者的医疗状况的影响， 治疗，重症监护室设备，以及患者无法 注意自己的口腔护理。 它们的口腔里 潜在的VAP病原体，对口腔健康状况知之甚少， 机械通气患者的局部口咽免疫。 作为 由于严重疾病，宿主的口腔防御很可能是 暴露了 体位与口腔护理干预 护理可以帮助减少VAP。 然而，在开发和 护理干预的测试，有必要描述具体的 靠背高度和口腔健康状况对儿童口腔发育的影响 VAP。 本研究的具体目的是描述1） 靠背抬高对VAP发生的影响; 口腔健康状况对呼吸机相关性肺炎的影响。 该研究是一项非实验性、纵向、描述性设计， 患者作为分析单位。 VAP将使用临床 肺部感染评分。 靠背高度将使用 传感测量系统 口腔健康状况包括生物 测量（唾液乳铁蛋白和伊加）和口腔健康评估。 数据将从病历、生物体液（唾液和 气管内导管抽吸物）并从床旁监测下载 系统中的60名受试者中的每一名在7天的时间段内进行测试，并使用 混合线性模型

DESCRIPTION (Adapted from the Investigator's Abstract): Pneumonia is the leading cause of death from nosocomial infections and the second most common nosocomial infection in the US. Intubation and mechanical ventilation greatly increase the risk of bacterial ventilator associated pneumonia (VAP). Patients in ICUs are particularly vulnerable because the common ICU procedures of intubation and mechanical ventilation greatly increase the risk for bacterial VAP. In addition, the supine position, frequently used by nurses in ICUs to manage problems associated with unstable hemodynamic status, further increases the risk of VAP. Although the Centers for Disease Control and Prevention recommend the use of higher backrest positions (30-45 degrees) in mechanically ventilated patients, definitive scientific studies have not yet been done to support this recommendation. In addition to the supine position, bacterial colonization of the oropharynx is also an important risk factor for VAP. Oral health status of mechanically ventilated patients may be compromised by the patient's medical condition, treatments, intensive care unit equipment, and the patient's inability to attend to his or her own oral care. Their oral cavity is colonized with potential VAP pathogens and little is known about the oral health status or local oropharyngeal immunity in mechanically ventilated patients. As a result of critical illness, it is likely that host oral defenses are compromised. Nursing interventions related to patient positioning and oral care may assist in decreasing VAP. However, prior to the development and testing of nursing interventions it is necessary to delineate the specific effect of backrest elevation and oral health status on the development of VAP. The specific aims of this study are to describe 1) the relationship of backrest elevation on the development of VAP; and 2) the relationship of oral health status on the development of ventilator associated pneumonia. The study is a non-experimental, longitudinal, descriptive design with the patient as the unit of analysis. VAP will be quantified using the Clinical Pulmonary Infection Score. Backrest elevation will be monitored using a transduced measurement system. Oral health status includes biological measurement (salivary lactoferrin and IgA) and an oral health assessment. Data will be obtained from the medical record, biological fluids (saliva and endotracheal tube aspirates) and downloaded from the bedside monitoring system over a 7 day period for each of 60 subjects and analyzed using a mixed linear model.