The Effect Of Closed Suction System To Ventilator-associated Pneumonia And Respiratory Mechanics In Mechanical Ventilation Patients

Part 1 The effect of closed suction system to Ventilator-associatedpneumonia in mechanical ventilator patientsObjective Comparing the effect of ventilator-associated pneumonia incidence betweenmechanically ventilated patients having endotracheal suction by an open and closed suctionmethod.Methods Analysis of clinical data and pathogens characteristics of 59 cases in ICU whichreceived mechanical ventilation. The inclusion criteria were: patients older than 18years,establish artificial airway in ICU, underwent mechanical ventilation for more than 48 hours.The patients were divided into two groups. Group A 29 patients （49.15％） receivedclosed-tracheal suction. Group B 30 patients （50.85％） received open-tracheal suction.Basic data of patients which include age, sex, primary disease, use antibiotic in antephase,use antacid in antephase, use steroid in antephase and the Acute Physiology and ChronicHealth EvaluationⅡ（APACHEⅡ） were collected. VAP diagnosis standard was 2002Chinese Medical Association（CMS） nonsocial aquired pneumonia diagnosis and treatmentguide. Clinical data include: body temperature, hemogram, chest x-ray film, bacterialculture and drug sensitivity test of secreta in lower respiratory, and chest auscultation.Result 1 There was no significant difference between two groups in age, sex, primarydisease, use antibiotic in antephase, use antacid in antephase, use steroid in antephase, andthe Acute Physiology and Chronic Health EvaluationⅡ（APACHEⅡ）（P＞0.05）. 2Incidence of total VAP and delay VAP in group A （23.73％, 8.47％） were less than group B,there was a significant difference between two groups （P＜0.05）. Although early VAPpatients in group A was more than group B, there was no significant difference in incidenceof early VAP between two groups（P＞0.05）. 3 There was no significant difference inprognosis which include improve,not improve, and fatality between two groups （P＞0.05）.3 Average mechanical ventilation duration and average length of stay in ICU of group A was obviously lower than B groups （P＜0.05）. 4 Group A main infected one pathogenicbacterium（41.38％）, the pathogenic bacterium of group B infected was more than twotypes（53.33％）. There was a significant difference between two groups （P＜0.05）. 5 TheGram-Negative bacillus distribution in group A was 63.74％,and in group B was 75.89％.The Gram-Positive bacillus distribution in two groups were 20.88％and 14.89％, andeumycete were 15.68％and 9.22％. There was a significant differenc in disposition ofpathogenic bacterium between two groups （P＜0.05）. The drug resistant of baumanii,Pseudomonas aernginosa, Stenotrophomonas maltophilia, Klebsiella pneumoniae,Staphylococcus aureus and eumycete were no significant difference between two groups.And infection of fungus was serious（P＞0.05）.Conclusion Use of a closed suction system could decrease the incidence ofventilator-associated pneumonia, shorten mechaniacal ventilation duration, and decurtatethe length of stay in ICU. But closed suction system did not have a significant effect onprognosis of patients.Part 2 The effect of closed suction system to gas exchange andrespiratory mechanics in mechanical ventilator patientsObjection Comparing the effect of closed suction system and open suction system tolung ventilation and gas exchange in mechanical ventilated patients.Method 40 patients who were on mechanical ventilation and older than 18 years in ICUwere enrolled. Open suction system（include open suction tube and heated humidifier） andclosed suction system （include closed suction tube, heated and moisture exchanger）techniques were performed on patients by a randomized way. 1. The data of arteries bloodgas at 2 minutes before suction, 30 sections after suction and 5 minutes after suction wereobtained. The data of oxygen saturation by pulse oximetry （SpO₂） were collected during the procedure of suction. 2. The data of inspiratory peak pressure（Ppeak）, inspiratory plateaupressure（Pplat） and pulmonary static compliance（Cst） were recorded before suction and 2minutes after suction.Result 1. There was a significant decrease in arterial oxygen partial pressure（PaO₂）,arterial oxygenation（SaO₂） and SpO₂ after suction in OS group （P＜0.05）. There was nosignificant difference of oxygen partial pressure（PaO₂）, arterial oxygenation（SaO₂）andSpO₂ before and after suction in CS group （P＞0.05）. 2. There was a significant increasingin the data of Pplat after suction compared to before suction in OS group （P＜0.5）. And thedata of Ppeak, Cst which after suction were lower than before suction in OS group,therewas a significant difference （P＜0.5）. The data of Ppeak、Pplat and Cst in CS group wereno significant differente between before and after CS （P＞0.05）.Conclusion 1. Closed suction system did not impact gas exchange in mechanicalventilator. 2. Open suction system had obvious influencing on airway pressure and Cst,and decrease arterial oxygen pressure.Part3 Dependablity of differentiation of symptoms and signs withtraditional Chinese medicine way with VAPObjection Analysis the differention of symptoms and signs with traditional Chinesemedicine way on mechanical ventilation patients. To provide a better method of suctiongfor clinical treatment.Method 59 surgical and medical patients who were on mechanical ventilation and olderthan 18 years in ICU were enrolled. Analysis the patients based on coated tongue, pulsetracings, and clinical manifestation.Result Patients of Heat-phlegm （66.10％） were more than that of cold-phlegm （33.90％）. Patients of heat-phlegm type（64.10％） was more than the ones with cold-phlegrn（50％）, there was a significant difference between two types（P＜0.05）,Conclusion Mainly VAP patients were heat-phlegm,and patients with cold-phlegm wereless.