Research On Airway Moist Modes In Patients With Tracheotomy

Part I: A-meta Analysis on Effects of two different Airway Moist Modes ObjectiveTo compare the effects of continual endotracheal instillation and atomization inhalation by meta-analysis,and to provide supportive evidence and suggestions for clinical work.MethodsTwo researchers scanned online database,including Pubmed,EMBASE,JBI evidence-based nursing center library,the Cochrane Library and Chinese databases(CNKI,Wanfang database,VIP,CBM)systematically from January 2015 up to September,2016.Randomized controlled trials(RCTs)are adopted to test the effectiveness of two airway moist modes in patients with tracheotomy.Atomization inhalation was used in the experiment group,while endotracheal instillation was used in the control group.Cochrane Handbook(5.1.0.2011)was used to screen literatures and extract data and then meta-analysis was conducted.ResultsOnly those consistent with the four clinical outcomes described in the literatures were included,and the result of meta-analysis indicated that atomization inhalation was shown to be superior to continual endotracheal instillation in sputum density,bloody sputum,irritable dry cough,pulmonary infection.The stability of the research is verified by sensitive analysis,and the funnel plots were largely symmetrical,suggesting there was no publication bias in the meta-analysis.Conclusion1.Atomization inhalation lowers sputum density and the incidence of complications caused by lack of humidification,so it is a more appropriate mode of airway humidifying.2.Endotracheal instillation leads to a rise of complication incidence rate,which confirms American Association for respiratory Care,AARC's point of view that ?Endotracheal instillation is not recommended".Part II Observational Research on Different Frequency of Two Humidification Fluids' effects on airway of patients with tracheotomyObjectivesBy comparing subjective and objective indicators of sputum specimen as well as patient comfort,cough frequnecncy and degree of airway ventilation,thus to evaluate the effectiveness of different frequency of medication with Na Cl and ambroxol hydrochloride solution,expecting to provide supportive evidence for setting the standard of airway humidifying after tracheotomy.MethodsRandomized controlled trial is adopted in this research.One hundred and twenty patients with tracheotomy who were in Xijing Hospital and Tangdu Hospital were sampled and divided into four groups(Group A,Group B,Group C,Group D)randomly by ?The Envelope Method? during September 2015 to September 2016.Patients in group A were given 6 ml 0.45% Na Cl solution and 15mg(2ml)ambroxol hydrochloride solution,3 times per day;Patients in group B were given 6 ml 0.45% Na Cl solution and 15mg(2ml)ambroxol hydrochloride solution,6 times per day;patients in group C were given 8ml 1.25%Na HCO3,3 times per day;Patients in group D were given 8ml 1.25% Na HCO3,6 times per day.Compare the differences between four groups and self-compare each group from the indicators of sputum PH value,sputum density,pulmonary infections,blood in sputum,sputum scab formation,patient comfort,irritable cough frequency,degree of airway ventilation at 3 different timing after tracheotomy.Results1.Comparison of Sputum PH value indicates: Group B is superior to group A,C on the 1st and 7th day after tracheotomy;and there is a statistical difference with group D on the 4th day after tracheotomy(p<0.05),and the average value is higher than group D;Sputum PH value of group B is on a rising trend over time.2.Comparison of sputum density indicates: There is no statistical difference on the 1st,4th and 7th days.The highest rate of III? severe phlegm occurrence existed in group C and it is up to 16%.3.The indications of pulmonary infections,blood in sputum,sputum scab formation is rather low there is no statistical significance.4.Patient comfort indication comparison: group B is superior to group C on the 1st,4th and 7th days after tracheotomy,and is superior to group A on the 1st and 4th days after tracheotomy,there is a statistical difference(P<0.05).Self-comparison of group B indicates a descending trend with a statistical significance as time goes by(P<0.05).There is no statistical difference between group B and group D on patient comfort indication.5.Cough frequency indication Comparison: Group B is superior to group A and C on the 1st,4th and 7th day after tracheotomy,and there is a statistical difference(P<0.05);There is also a statistical difference on the self-comparison of group B on the 1st,4th and 7th days after tracheotomy(P?0.05)and it is a descending trend on the whole.There is no statistical difference between group B and group D.6.Degree of airway ventilation comparison: group B is superior to group A and group C with a statistical significance(P?0.05);There is a statistical difference on the 1st and 4th days of self-comparison of group B with a descending trend on the whole while no statistical significance on the 4th and 7th day;There is no statistical significance between group B and group D.Conclusion:1.Ambroxol Hydrochloride's excellent effect on diluting sputum at the early stage after tracheotomy enables it to dilute sputum instantly,lower airway inflammatory response and accelerate the recovery of mucociliary systematic function,relieving patients' pain.2.6 times per day is a more appropriate frequency of medication than 3 times per day for atomization inhalation.3.Ambroxol hydro-chloride inhalation therapy could provide warming and humidifying atomizing gas that fits physiological needs of patients,at the same time it is also a promoting measure of recovery of mucociliary systematic function.To make use of mucus function to compensate part of the physiological function of upper airways is a more economic and effective approach.