The Effects Of Subglottic Fluid Removal Method On Ventilator-associated Pneumonia

Objective:Ventilator-associated pneumonia (VAP) is one of the common and severe complications during the mechanical ventilation (MV), which usually occurs in stomach-oropharyngeal-subglottic-lung way. This study aimed to discuss the effect of pure subglottic flush and/or combined with oropharyngeal flush on the subglottic, bacterial lower respiratory tract and the incidence of VAP, Simultaneously, the time of MV, the length of ICU stay (LOS) and mortality, were also observed which in order to implement a better airway to care patients in clinical MV and provide a reference for prevention of VAP.Methods.57patients who were administered from January2011to December2011, were randomized into2groups.30persons for A group.27persons for B group. In group A, conventional airway care based on Q8H subglottic irrigation. Contrastly, conventional airway care based on Q8H subglottic combined oropharyngeal rinse for group B. To collect the subglottic secretions and the lower airway secretions by sterile sputum collected bottles in early morning after tracheal intubation (MV) within48h,4d,7d. To record the incidence of VAP, the time of MV, the length of ICU stay, mortality, and distribution of pathogen.Results:1. The incidence of VAP:The incidence of VAP is61.40%, the comparison incidence of VAP in tow groups of MV<5days was statistically significant (p<0.05). At the same time, the comparison incidence of VAP in tow groups of MV>5days was not statistically significant (p>0.05).2. The time of MV, the length of ICU stay, mortality:The comparison of the time of MV, the length of ICU stay, mortality in two groups were not statistically significant (p>0.05). The time of MV and the length of ICU stay of the patients with VAP compared the patients not with VAP were statistically significant (p <0.05). The comparison mortality in two groups was not statistically significant (p>0.05).3. The distribution pathogens:223samples of the lower airway secretions were examined, and202strain bacteria were isolated, among the pathogen in lower airway secretions gram negative bacteria (GNB) was54.46%, eumycete was25.74%, gram positive coccus (GPC) was19.80%;115samples of the subglottic secretions were send,173strain bacteria were isolated, among the pathogen in subglottic secretions gram-negative bacteria was48.55%, eumycete was28.32%, gram-positive bacteria was23.12%; The sequence of3leading pathogen were acinetobacter baumannii, candida albicans, staphylococcus aureus; Two groups lower respiratory tract secretions and subgiottic secretion pathogens constituent ratio in which the comparison result of gram-negative bacteria, eumycete, gram-positive bacteria were not statistically significant (p>0.05).4. Consistency of pathogen of lower airway secretions and subglottic secretions in two groups with VAP:Consistent rate of pathogen of lower airway secretions and subglottic secretions in two groups with VAP was54.29%.Conclusion:1. It is lower incidence of early-VAP in subglottic combined with oropharyngeal flush than pure subglottic flush.2. The occurrence of VAP can significantly prolongs the time of MV and the length of ICU stay.3. The dominant bacteria cultured in the lower airway secretions and subglottic secretions of MV patients is GNB. The top three pathogens are acinetobacter baumannii, candida albicans, staphylococcus aureus.4. The patients with VAP have illustrated the VAP having some relationship with the breeding and migration of subgiottic secretion pathogenic bacteria.