Clinical Analysis On Preventing VAP In General ICU By The Ventilator Care Bundles

Objective:Ventilator-associated pneumonia (VAP) is a kind of hospitalacquired pneumonia (HAP) which is harmful to the health of the patients,and its infection rate is in the first place. According to the statistics, athome and abroad, VAP has both the high incidence rate and mortalityrate, and at the same time it prolonged hospitalization in patients,increased the medical resource and hospitalization expenses. To knowabout the clinical compliance of the ventilator care bundles (VCB) in thecomprehensive intensive care unit (ICU); to investigate the impact ofVCB on the infection rate of VAP, and to provide some reference forclinically preventing VAP．Methods:This research adopts randomized controlled method. One hundredand twenty patients who used mechanical ventilation were divided intothe control group and intervention group from January2012to December2013in comprehensive ICU. The control group were implemented theroutine nursing measures of ICU wards, and the intervention group withventilator care bundles. The MV time, the ICU length of stay, the amountof VAP and executive condition of the intervening measure werestatistically recorded and analyzed.Results:(1) The control group and the intervention group, which werecompared in gender, age, chronic diseases, and manners of artificialairway, showed no statistical significance (p>0.05).(2)By the statistics,VAP infection amount of the control group was13patients, the MV time554days, the ICU length of stay717days, and infection rate23.42‰; VAP infection amount of the intervention group was5patients, the MVtime421days, the ICU length of stay558days, and the infection rate11.88‰.(3) With longer duration of the MV, the target rate of dumpingof condensed water, raising the head of a bed, breathing loop of oral careis falling, statistically significant differences between the three stageswere shown (p <0.05).(4) With an elevation angle of bed less than30°,the incidence of VAP was23.53%. Along with the rising of the elevationangle of the bed, the incidence of VAP decreased obviously (p <0.05);With a pH of gastric juice more than4, the incidence of VAP was20.55%;with the increase of pH value of gastric juice, the incidence of VAP alsoincreased significantly (P <0.05);With a gastric residual volume morethan200ml, the incidence of VAP was20.90%, with the increase of GRV,the incidence of VAP increased significantly (p <0.05).Conclusions:(1) Taking VCB measures can effectively reduce the incidence rateof VAP, shorten the time of MV and ICU hospitalization days.(2) Manyfactors affect the execution of VCB, with longer duration of the MV, theadherence of dumping of condensed water, raising the head of a bed,breathing loop of oral care is falling.(3) Elevation angle of the head of abed, GRV and the pH of gastric juice is closely related to the VAPoccurrence, the angle of bed up less than30°, the GRV more than200mland the increase of pH value more than4by vomiting or regurgitationand aspiration increase the risk of VAP occurs.