Study On The Efficacy Of Different Methods Of Subglottic Secretion Drainage In Patients With Tracheotomy

Objective:To explore the preventive of different subglottic secretions drainage in patients with tracheotomy.Methods:Totally90patients with tracheotomy received mechanical ventilation for over48hours were randomly divided into group A, B and C. Group A received continuous suction of subglottic secretion with interval wash; group B received2hours intermittent suction with interval wash; group C received4hours intermittent suction with interval wash. Three groups were observed and recorded the occurrence of VAP (temperature, white blood cell count, chest X-ray results, VAP occurrence time, incidence, duration of mechanical ventilation); attract effects:sputum and subglottic secretion volume, bacterial culture of samples from the throat swab, the subglottic secretions and lower respiratory tract secretion, and the fingertip blood oxygen saturation, arterial blood gas; attract adverse reactions:cough, tracheal mucosal damage, catheter blockage; the occurrence of28-day mortality; Rating (disease condition score, APACHE II coma score, Glasgow score).Results:1. There were no significant differences among three groups in the time of onset and incidence of ventilator-associated pneumonia,duration of mechanical ventilation and hospitalization,28-day mortality rate (P>0.05).2. There were no significant differences among with bacterial culture from throat swab, subglottic secretions and sputum in patients with tracheotomy (P>0.05), there wereGram-negative bacteria mainly, acinetobacter baumannii and pseudomonas aeruginosacells accounted advantage, Gram-positive bacilli methicillin-resistant Staphylococcus aureus.3. There were no significant differences among three groups volume of sputum and subglottic secretions (P>0.05).4. There were no significant differences among three groups in results of routine blood and arterial blood gas (P>0.05).5. There were significant differences among three groups in vital signs, cough and injury of tracheal mucous,obstruction of the drainage tube related complications,(P< 0.05).Conclusion:1.The prevention of VAP effect in continuous suction of subglottic secretion with interval wash,2hours and4hours intermittent suction with interval wash was similar. Compare with the fewer complications, intermittent suction was better.2. Bacterial culture from throat swab, subglottic secretions and sputum in patients with tracheotomy of pathogen bacteria and constitute of more consistent.3. Combined nurse workload,time allocation,in terms of the critically ill patients clinical attention operability,4hours intermittent subglottic secretion drainage with interval wash was a scientifically and reasonable methods worth in the clinical application。...