Removal Of Retentate On The Balloon With Different Irrigation Fluids To Prevent Ventilator-associated Pneumonia Clinical Research

PurposesIn this study,the secretions from the balloon were removed by using the intermittent glottal irrigation combined with the ventilator's breath-holding airflow impact method..It is To investigate the effect of 0.9%sodium chloride injection and 0.02%chlorhexidine solution on the incidence of bacterial colonization and ventilator-associated pneumonia in patients with tracheal intubation.Methods100 patients with mechanical ventilation of tracheal intubation from December 2016to July 2018 in the Department of Critical Care Medicine which belongs to a 3A grade hospital in Heze were selected for the prevention of VAP.Among them,68 male patients and 32 female patients were randomized.Divided into experimental group and control group,each group of 50 people.The secretions on the balloon were removed by subglottic irrigation combined with airflow shock in the two groups.The control group was treated with 0.9%sodium chloride injection,and the experimental group was incubated with0.02%chlorhexidine solution every 4 hours.The mechanical ventilation time,ICU hospitalization time,secondary intubation rate,28-day mortality,number of VAP cases,time of occurrence,daily subglottic suction and lower respiratory tract sputum volume and tracheal intubation were recorded.Bacteria culture of lower respiratory tract on the 1st,4^thh and 7 ^th.Data processing and analysis were performed using SPSS21.0 statistical software.Measurement data were expressed as mean±standard deviation??,using t test;counting data were described by frequency and composition ratio,using?² test,P<0.05 indicates that the difference was statistically significant.Results1.The incidence of VAP in the experimental group?6%?was significantly lower than that in the control group?20%?,and the difference was statistically significant?P=0.037?.The incidence of advanced VAP in the experimental group?4%?was also significantly higher than that in the control group?16%?and the difference was statistically significant?P=0.047?.The incidence of early VAP was lower in the experimental group?2%?than that in the control group?4%?,and the difference was not statistically significant?P>0.05?.2.The mechanical ventilation time was 10.78±3.18 and 9.42±2.93 in the control group and the experimental group.The ICU hospitalization time was 13.28±4.29 and11.60±3.68,respectively.The experimental group was less than the control group,and the difference was statistically significant.Significance,P<0.05.There were no significant differences between the two groups in the 28-day mortality rate,daily subglottic and lower respiratory secretions,P>0.05.3.Two groups of glottic secretions were taken for culture.The positive rate of the experimental group?39/148,26.35%?was significantly lower than that of the control group?71/149,47.65%?.There was no significant difference between the two groups on the first day?P>0.05?.The experimental groups on the 4th and 7th day were less than the control group,and the difference was statistically significant.?P<0.05?4.The lower respiratory tract sputum was taken for culture.The positive rate of the experimental group?29/148,19.59%?was lower than that of the control group?36/149,24.16%?.On the 1st,4th and 7th days,there was no significant difference between the experimental group and the control group?P>0.05?.5.Select two groups of qualified secretions for sputum culture,analyze the distribution and composition ratio of the flora,and the experimental group and the control group on the balloon were mainly Gram-negative bacteria,and the composition ratio of Acinetobacter baumannii accounted for 34.78%?35.8%;the lower respiratory sputum sputum was mainly Gram-negative bacteria,and the composition of Acinetobacter baumannii accounted for 35.14%and 36.36%,respectively,in the experimental group and the control group.The pathogens in the two groups were similar.Conclusions1.For ICU endotracheal intubation mechanical ventilation,0.02%chlorhexidine solution subglottic irrigation is more effective than 0.9%sodium chloride injection to reduce the bacterial setting under the glottis area of??the balloon,reducing the source of the drug pathogen of VAP,reducing mechanical ventilation time and ICU stay time,reducing the incidence of VAP.2.The chlorhexidine rinse can effectively reduce the bacterial value in the area under the glottis,reduce the positive rate of pathogenic bacteria culture,and has no significant effect on the positive rate of pathogenic bacteria in the lower respiratory tract.3.In the mechanical ventilation patients,the bacterial culture on the airway retentate and the lower respiratory tract secretion were mainly Gram-negative bacteria,and Acinetobacter baumannii dominated.4.The suction under the intermittent glottis is combined with chlorhexidine rinsing and combined with the ventilator's breath-holding airflow impact method,which is worthy of clinical application.