Analysis Of Risk Factors Of VAP In Patients With Mechanical Ventilation In ICU And Application Research Of Ventilator Care Bundles

Objective:To investigate the risk factors of ventilator-associated pneumonia in patients with mechanical ventilation,and to use the multi-criteria decision analysis method based on the survey results,and to combine the domestic and international research results to build a comprehensive,safe and effective ventilator care bundles,and apply the constructed nursing program to the machine.In patients with ventilation,the effect of this regimen on the incidence of ventilator-associated pneumonia,APACHE II score,mechanical ventilation time,and pathogen detection rate in mechanical ventilation patients was investigated.Methods:The first part is an observational study:a retrospective case-control study was conducted to select 236 patients with a mechanical ventilation of more than 48 hours from January 2016 to March 2018 in a top three general hospital in Taiyuan city.Group and non-infected groups were surveyed according to the self-designed general data questionnaire and data were collected.Data were entered using Excel software,statistical analysis was performed using SPSS21.0,and risk factors for ventilator-associated pneumonia in mechanically ventilated patients were screened by single factor analysis and logistic regression analysis.The second part:based on the literature analysis method,the multi-criteria decision analysis method is used to optimize the program.Firstly,the research team conducts a large number of literature research,and combines relevant domestic and foreign guidelines to draft the preliminary draft of the intervention plan.Based on the multi-criteria decision analysis method,the expert consultation questionnaire,using the purpose sampling method to extract 14 experts from the same top three general hospitals for questionnaire consultation,calculate the average weight of each criterion and the average score of each intervention under each criterion,and then calculate the product of the two,according to the size of the score,the top six items with the highest scores constitute a ventilator care bundles.The data was entered and calculated using Excel software.The third part is an experimental study:104 patients with mechanical ventilation in the comprehensive ICU ward of a third-grade hospital in Taiyuan city from April2018 to February 2019 were randomly selected according to the random number table method.The patients were divided into intervention group and control group,52 cases in each group.The control group received routine nursing intervention.The intervention group increased the ventilator care bundles based on the control group's nursing.The data collection was carried out by using the self-designed mechanical ventilation patient related data questionnaire.Statistical analysis was performed using SPSS21.0.Baseline data and the number of infections between groups were compared by?² tests.The mechanical ventilation time and APACHE II scores between groups were compared by nonparametric tests.Results:1.Univariate analysis showed age,underlying disease,previous history of COPD,history of diabetes,use of acid-suppressing agents,nasal feeding,glucocorticoids,consciousstate,conventionalairwayhumidification,hypoproteinemia,mechanical ventilation Time,condensate exchange,APACHE II score,and secondary intubation were the relevant factors for VAP.Multivariate logistic regression analysis showed that the underlying diseases>2,age>60 years,nasal feeding through the stomach,and glucocorticoids>7 days,coma,hypoproteinemia,APACHE II score>15,mechanical ventilation time>7 days,secondary intubation is an independent risk factor for VAP in patients.2.Based on a large number of literature studies,combined with relevant guidelines at home and abroad,the research team initially established nine aspects of nursing issues:posture intervention,oral care,respiratory care,ventilator care,nutritional support,sedation intervention,prevention of nosocomial infection,prevention Stress ulcer,rehabilitation training,20 specific interventions;6multi-criteria decision-making analysis to optimize the ventilator care bundles:?1?Encourage early activities and early rehabilitation training;?2?0.12%chlorhexidine oral care,4 times/day;?3?No special contraindications to raise the bed head 30°⁴5°;?4?Continuous subglottic secretions suction,keep the airbag pressure between25³0cmH₂O;?5?Daily wake-up training for spontaneous breathing and evaluation of whether or not the machine can be withdrawn;?6?Dumping the condensate in the ventilator line in time,the collection bottle is at a low position.3.After the intervention treatment group was treated with ventilator care bundles,the incidence of ventilator-associated pneumonia in the intervention group was significantly lower than that in the control group,the difference was statistically significant?P<0.05?,and the APACHE II score,mechanical ventilation time,the difference in bacterial detection rate was statistically significant?P<0.05?.Conclusion:1.The risk factors for ventilator-associated pneumonia come from autoimmunity,nursing and medical care.Comprehensive improvement of patients'own immunity,intensive care and rational use of drugs can help reduce the risk of ventilator-associated pneumonia.2.Multi-criteria decision analysis method is based on a series of criteria for experts to determine the execution order or recommendation degree of each strategy through quantitative weights,which excludes the subjectivity of researchers and has certain scientific nature,which is conducive to improving the recognition of clinical nurses.3.Ventilator care bundles can effectively reduce the incidence of ventilator-associated pneumonia in mechanical ventilation patients,and at the same time,shorten the mechanical ventilation time of patients,reduce the APACHE II score of patients,and reduce the detection rate of pathogenic bacteria.