Clinic Observation Of Bundle Treatment Ventilator-associated Pneumonia Of Cerebral Disease

Objective:Because of severe cerebral patients length of stay (LOS), high cost and easily complicate ventilator-associated pneumonia during ICU, difficultly treatment and poor prognosis, we design the prospective randomized control trail to study Bundle care whether it can decrease LOS and cost during staying ICU, and valuated prognosis value of Bundle care.Methods:My study includes 20 cases that they have been remained from 687 cases patients who had severe cerebral disease in our first affiliated hospital of Xinjiang Medical University. All this cases have been diagnosed ventilator-associated pneumonia by excluded from non-ventilator-associated pneumonia and the age>18years. They have been divided into controlled group (9 cases) and experiment group (11 cases). Two groups have been observed from duration and expense of ICU. The controlled group and the experiment group are the same foundation therapy. There are the same therapeutic measures as follow:(1).Actively treating primary disease. (2).Actively controlling infection. (3).Protecting main organs reasonably maintaining nutrition and avoiding needless blood transfusion. (4).Probably keeping patients partly lying. (5) Reasonably keeping patients calm. Invest gating severity of diseases every day, early stopping using ventilator and displeasing air tube in the trachea through ora and pharynx, early cutting trachea operation if needing long mechanical ventilation. (6).Preventing deep venous thrombus. (7).Avoiding hospital intercrossed infection. (8).Enhancing administration in the ICU. The experiment group adds to therapy as follow:(1). Reasonable using antibiotics from director of intensiveists. (2).Tooth brushing twice every day. 2%Chlorhexidine and 4%NaHCO3 used in turn to clean in the ora and pharynx every50ml every 6h. Suction every 1h. Keeping 0.90%NaCl drop. (3).Increasing bed head 30～40°if no contraindication. (4) Visualization suction sputum using bronchofibroscope. (5) Intramuscular injection thymic peptide-a once a day. Results:The experiment group and the controlled group do not differ in age, sex and the APACHE II in the statistics. Experiment group LOS of ICU 13.902±2.702 (CI:8.605～19.198) days, Controlled group LOS of ICU 17.194±2.228 (CI:12.827～21.562) days. Their incidence significantly differs in the statistics. Experiment group cost of ICU 5.8281±2.908 wan yuan, Controlled group cost of ICU 7.0391±1.416 wan yuan (P=0.041), There are significantly differs in the statistics.Conclusion:Bundle care can obviously reduce LOS of ICU and decreasing cost of ICU. Moreover effect of the VAP Bundle care is worth trusting.