The Effect Of Implementation Time Of The First Time Oral Care On The Incidence Of Early-onset Ventilator-associated Pneumonia In Patients With Endotracheal Intubation

Objective:With the deepening research on the effect of oral care for VAP prevention, more and more scholars suggest that oral care as an important measure to prevent VAP. The related research for oral care mainly focused on the method of oral care, oral care solution, oral care frequency, implementation time of the first time oral care and selective oropharyngeal decontamination. There is no unified standard on implementation time of the first time oral care for critically ill patients with endotracheal intubation in ICU, which are usually based on the specific clinical situation and the workload of the nurse. We hope to find a best oral care intervention time through this research, in order to effectively prevent the early onset of VAP, shorten the duration of mechanical ventilation and length of stay in the intensive care unit, reduce the cost of the patients, provide guidance for specific clinical practice and make clinical nursing work get rid of blindness. Methods:The patients with endotracheal intubation for mechanical ventilation in the ICU of our hospital from June 2014 to June 2015 were as the research object. According to the inclusion and exclusion criteria, the collection number of cases was 130. The objects of study were randomly divided into group A?group B and group C, and the implementation of oral care for the first time in the three groups was within 4h(4h included) after intubation, 4h~8h(8h included) after intubation, 8h~12h(12h included) after intubation, respectively. But in the process of clinical follow-up, there were 10 patients fall off, so the ultimate collection number of cases was 120, and there were 40 people in each group. The baseline data of patients on admission in three groups were collected and compared between groups. Tracking the related monitoring index of early-onset ventilator-associated pneumonia of patients, and judging whether had happened early-onset ventilator-associated pneumonia according to the diagnostic criteria. Meanwhile, recording the patients' offline time and deaths, and calculating the total duration of mechanical ventilation, the length of stay in the intensive care unit and mortality when patients out of ICU. Some indicators in the three groups were compared, such as incidence of early-onset ventilator-associated pneumonia, duration of mechanical ventilation, length of stay in the intensive care unit, mortality, etc.To support the conclusion on the prophase research, late research analyzed the sputum culture results within 96 h after endotracheal intubation of patients in group A?group B and group C. The pathogenic bacteria strains separated from sputum culture, positive rate and mixed bacteria infection rate of sputum culture of patients in three groups were compared. And discuss the relationship between sputum culture positive and early-onset ventilator-associated pneumonia, the relationship between mixed bacteria infection and early-onset ventilator-associated pneumonia within 96 h after endotracheal intubation. At last, the patients were divided into early-onset VAP group and non-VAP group according to they whether hapened early-onset ventilator-associated pneumonia or not. The distribution and composition of pathogenic bacteria of patients in different groups were analyzed, then concluding the pathogenic spectrum of early-onset ventilator-associated pneumonia. Results:1. The variable of patients in group A, group B and group C, such as age, sex, APACHE ? score, diagnosis on admission, smoking history, whether go through surgery, whether use antibiotics before intubation and whether use a sedative after intubation was no statistically significant difference(P>0.05).2. The incidence of early-onset ventilator-associated pneumonia in group A?group B and group C had no statistical difference(P>0.05). However, the incidence of early-onset ventilator-associated pneumonia in the three groups was gradually increased.3. The duration of mechanical ventilation and the length of stay in the intensive care unit had statistical difference in group A?group B and group C(P<0.05). And further multiple comparison through LSD method showed that the duration of mechanical ventilation and the length of stay in the intensive care unit comparison between any two means had significant difference in patients of group A?group B and group C(P<0.05), and the duration of mechanical ventilation and the length of stay in the intensive care unit in the three groups were gradually prolonged.4. The mortality in group A?group B and group C had no statistical difference(P>0.05). However, the mortality in the three groups was gradually increased.5. By means of analyzing sputum culture results within 96 h after intubation of patients, we found that the quantity of pathogenic bacteria separated from sputum culture, positive rate of sputum culture and infection rate of mixed bacteria in group A?group B and group C all showed a gradually increasing trend. However, the positive rate of sputum culture and infection rate of mixed bacteria in group A?group B and group C had no significant statistical difference(P>0.05).6. When comparing the incidence of early-onset ventilator-associated pneumonia between patients who sputum culture was positie and patients who sputum culture was negatie within 96 h after endotracheal intubation, we found that there was no significant statistical difference(P>0.05). However, the incidence of early-onset ventilator-associated pneumonia of patients who had mixed bacteria infection was significantly higher than the patients who had no mixed bacteria infection, and the difference was statistically significant(P<0.05). Further to make correlation analysis on mixed bacterium infection and early-onset ventilator-associated pneumonia, we found that they had significantly positive correlation(r=0.26, P<0.05).7. We found that gram negative bacilli was predominant in the pathogenic bacteria of early-onset VAP, followed by gram-positive cocci.Fungi accounts for only a few(G- refers to gram negative, G + refers to gram positive). Conclusions:The incidence of early-onset ventilator-associated pneumonia and mortality can be reduced, in the meantime, duration of mechanical ventilation and length of stay in the intensive care unit can be shortened if oral care for the first time implemented within 4h after intubation. All in all, the prognosis of patients can be obviously improved.