Study On The Application Of Different Intervals Of Subglottic Secretion Drainage In Mechanical Ventilation Patients

Objective:The best drainage interval is discussed through the comparison of the effect and adverse reactions of different drainage interval of subglottic secretion drainage on prevention of VAP.Methods:93 adult patients over 18 years old who need invasive mechanical ventilation and admitted to ICU and EICU of Jiangsu Province Hospital from February 2016 to September 2016 were chosen. The patients were randomly divided into A, B, C three groups according to the different drainage intervals(subglottic secretion drainage with interval wash shall be implemented every two or three or four hours) of intermittent subglottic secretion drainage. General information on the three groups of patients: including age, sex, basic disease, APACHE ?; occurrence situation of three groups of patients with VAP(occurrence time, incidence, the duration of ventilatory support of VAP);bacterial culture of samples from the subglottic secretions and lower respiratory tract secretion; the amount of secretion of hypolarynx of three groups, situation of airway mucosal injury 24 hours after intubation (visible mucus blooding, occult blood test of airway mucosa), tube plugging rate, frequency of irritating bulking, changes of heart rate and saturation of blood oxygen of drainage.Results:1. There was no statistical significance (P>0.05) in the incidence, occurrence time and the duration of ventilatory support of VAP in three groups.2. The difference of situation(visible mucus blooding, occult blood test of airway mucasa of airway mucasal injury 24 hours after buret and intubation of subglottic secretion drainage has stastistcial significance(P<0.05)3. There were no significant differences with bacterial culture from subglottic secretions and sputum in patients, there were Gram-negative bacteria mainly.4. The difference of changes of tube plugging rate, frequency of irritating bulking, heart rate for drainage and saturation of blood oxygen of three groups of patients has statistical significance (P<0.05)Conclusions:1. Subglottic secretion drainage with interval wash once every three hours not only can effectively reduce the amount of secretion on the air bag, but also can let tracheal epithelium on air bag get enough rest, in order to relieve the damage effect of negative pressure to tracheal epithelium; at the same time, to reduce frequency of irritating bulking and tube plugging.2.For nursing staffs, subglottic secretion drainage with interval wash once every three hours can reduce nursing workload, save medical resources, reduce bad stimulation to patients and improve comfort degree of patients, it is worthy of clinical popularization.