The Study Of Indications And Methods Of Tracheotomy Suction For Patients With Traumatic Brain Injures

Objective Aimed to investigate the status of tracheotomy suction indications, to set up andevaluate the indication system of tracheotomy suction, and to practice and evaluate theeffects of modified deep suction in tracheotomy patients with severe traumatic braininjuries.Methods (1)Questionnaire was utilized in75nurses to inquiry the frequency and priorityof tracheotomy suction indications.The consulting questionnaires include3categories and25items.Category A was symptoms,signs and symptoms caused by decrease of bloodoxygen when airway was obstructive,Category B was pulmonary signs and symptomscaused by cohesion of airway secretions,Category C was the actions of airway nursing.Theabove inquiries were launched3times.(2)Based on the result of literature reviewing, weinitially develop the indication system of tracheotomy suction for patients with severetraumatic brain injuries.Purposive sampling was employed to select40medical andnursing specialists in11hospitals,and we set up the final indication system.(3)Accordingto the clinical parameters of age≥18,admitting within6h after injury and GCS≤7,36caseswith severe traumatic brain injuries undergoing tracheotomy were admitted in ICU ofneurosurgery department from3hospitals.The following factors were observed beforesuction, which involved viscosity and quantity of sputum, change of HR, BR and SpO2,rales, interval between suctions, moist liquid dose for airway, cough.(4)Fourty cases withsevere traumatic brain injuries undergoing tracheotomy were admitted in ourinstitution.Inclusion criteria was as the same as the above.Consecutive cases were dividedas study and control group randomly.Patients in the control group followed the routinesuction methods.Patients in the study group followed the modified deep suction methods,inwhich the speed of insertion tube reduced as the tip over the cannula tip0.5cm.Bleedingand bronchoscopic status of airway mucosa, breath-hold time, bacteriological culture ofrespiratory secretions, patency of tracheotomy tube and CPIS were observed. Results (1)For the frequency of the indications,the5most commonly used includecategory A60%, category C40%;the15more commonly used include category A33.3%,category B53.3%,category C13.4%;the5lest commonly used include category A60%,category C40%.For the preference of the indications,the5highest priority includecategory A40%,category B20%,category C40%;the16higher priority include category A37.5%,category B43.75%,category C18.75%;the4lest priority include category A50%,category B50%.(2)Logistic regression analysis was used on130bouts of suction.Itshowed that the difference of active cough,change of SpO2, moist liquid dose forairway,change of BR,interval of physical therapy for lungs,and rales are significant (p＜0.05) as the quantity of sputum was dependent variable.P value of the regressioncoefficient of HR changes was0.08.The areas of ROC curve of the Logistic model,changeof BR,moist liquid dose for airway,change of SpO2,change of HR,interval of physicaltherapy for lungs were0.969,0.836,0.804,0.551,0.652and0.767.(3)Difference of CPISscores, bacteriological cultures,patency rates of tracheotomy tube between two groups wasun-significant.Injury rates of airway mucosa and breath-hold time showed statisticalsignificance (p=0.00) in study and control group.Conclusion (1)The indications of suction commonly used clinically classed as category Aand C.Rales,decrease of SpO2,cough,change of BR,viscosity of sputum,airway moist liquiddose,time after physiotherapy for pulmonary,time after previous suction,change of HR aresuggested to be indications of tracheotomy suction.(2)The indication system oftracheotomy suction for patients with severe traumatic brain injuries includes the following,①cough,②rales,③interval of physical therapy for lungs less than5.5min,④theaccumulative moist liquid dose for airway reaches11.0ml,⑤SpO2decreases by2.5%,⑥BR increase by17.65%,⑦HR increase by7.75%.Additionally,①②③④are mainindications,⑤and⑥are secondary indications,⑦is referenced indication.(3)Modifieddeep suction can reduce the injury of airway mucosa and the breath-hold time, help toreducing lung infection and maintaining patency.