The Studies On The Prevention Of Ventilator-associated Pneunonia By Strengthen Oropharyngeal Nursing

Background With the development of critical care medicine mechanicalventilation (MV) has been adopted more widely than ever before. MVnot only saves patients' lives but also gives rise to some complications.Ventilator-associated Pneumonia is one of the common and seriouscomplications during the period of Mechanical Ventilation. How toprevent VAP, to decrease the incidence of VAP has been a focus of thestudies about VAP in the world. The risk of VAP is present throughoutthe MV period, so in this period airway care is critical in preventingVAP. Infection is due to a disequilibrium between host defenses,inoculum size, and microorganism virulence. The research about the pathogenesis have achieved greaterprogress in recent ten years. Literatures in our and foreign countriesreported that the inhalation of Oropharyngeal colonization is ofparamount importance in the pathogenesis of VAP. These colonizedmicorganisms include bacteia from oral cavity, inner stomach and cuff.Neither microorganism virulence nor prior host diseases aremodifiable factors;however, the risk of VAP may be decreased byreducing the inoculum size. Selective decontamination of the digestive tract (SDD) decreasesincidences of VAP by eradicating microorganisms from the intestine,the stomach, and the oropharynx. However, the constant threat ofselection and overgrowth of antibiotic-resistant microorganisms, lackof formal cost-benefit analyses, and absence of beneficial effects onmortality rates have limited a widespread use of SDD Recentresearches have testified that a poor sanitary state of oral cavity isconnected with the incidence of VAP directly. Dental plaques,microorganisms and the immunity in oral cavity are the three mainfactors effected on the sanitary state of oral cavity. The mainpathogenic mechanism of VAP is the aspiration of contaminatedsecretions from the oropharynx into the lower airway. In patients withendotracheal intubation these secretions are pooled above the cuff ofthe ETT and may leak around the ETT, entering the lower respiratorytract. SSD is designed to reduce this process.ObjectiveTo systemic evaluation the effect of strengthen orapharyngealcare on prevention of VAP. Our study use a prospective, randomized,control experiment. Applying rinse with 0.9% brine and oral care withKoutai solution and Intermittent Subglottic Secretion Drainage todecrease the microorganisms deposited on the oropharynx of thepatients with Mechanical Ventilation. this way can cut off animportant approach to the incidence of VAP. And use other preventivemeasures together to reduce the incidence of VAP. Accordinglydiscuss the nursing projects that can prevent the onset of VAPeffectively.Materials and MethodsThis study is a prospective, randomized , control clinicalexperiment. Patients were randomly assigned either to experimentgroup (31patients) or control group (29 patients). The patients'oralcavity in experiment group are rinsed with 0.9% brine and cared withKoutai solution, two times a day. At the same time patients in thisgroup are applied with Intermittent Subglottic Secretion Drainage withKoutai solution, once four hours, 5-10ml every time. Patients incontrol group are applied oral care with 0.9% brine two times a day.Both are carried out oropharyngeal bacteria culture before and afteroral decontamination. And both are carried out sputum germiculturebefore oral decontamination. We do these works every two daysfrom the third day of MV to the day patients separated with ventilator.Simultaneously supervise the onset of VAP. Simultaneously, weenhance other prevention measures. Contrast the sputum germicultureand the microorganism colonization of oropharynx before and afteroral decontamination of two groups. Compare the incidence of VAP,early-onset VAP, later-onset VAP, the duration of MV and mortalityrate etc in two groups.Results1. There is no statistical difference in age, gender, APACHEIIscore, risks of VAP, underlying disease in two groups.2. The quantity of bacteria before oral decontamination hasevident difference in two groups (t=2.11,p=0.48<0.05);Either haveevident difference of bacteria count after oral decontaminationcompared with before oral decomtamination (the experiment group t=3.39,P=0.007<0.01;the control group t=5.590,p=0.000<0.01);there isprominent difference of pathogenic bacteria count after oraldecontamination between two groups (t= 2.716, p=0.013<0.05).3. The incidences of VAP in experiment group and control groupare 32.3%and 58.6%. The former is lower than the latter and thedifference have statistical significance (p=0.0001<0.01);Theearly-onset, later-onset of VAP and the time incidence of experimentgroup are all lower than that 0f the control group. The early-onset ofVAP of experiment group is 9.7%, that of control group is 17.2%;Thelater-onset of VAP of experiment group is 22.6%, that of control groupis 41.4%. The time incidence of VAP in experiment group is 34.36;incontrol group is 42.40%.4.There is no statistical difference in the duration of MV, days inhospital and mortality in two groups. the duration of MV andmortality in two groups are associated with APACHEII.Conclusion1. Microorganism colonized in oropharynx and subglottis isone of the important sources of pathogenic bacteria of VAP.2. Colonization of the oropharynx and subglottis is importantin the pathogenesis of VAP.3. The oropharygeal care measure of experiment groupdecrease the quantity of bacteria colonized in oropharynx effectively.4. The oropharygeal care measure of experiment group preventventilator associate pneumonia effectively. But its effect on theprognosis, duration of MV etc is need to be testified with furtherinvestigation.