Study On The Intervention Strategy Of Ventilator-associated Pneumonia In Patients With Liver Transplantation

ObjectiveTo explore the risk factors of ventilator-associated pneumonia in patients with liver transplantation,to understand the clinical compliance of ventilator-associated pneumonia cluster intervention strategy and its impact on the incidence of ventilator-associated pneumonia in patients with liver transplantation,to optimize the current cluster intervention strategy through multi-criteria decision analysis,to improve the compliance of medical staff with the guidelines,so as to reduce the incidence of the ventilatorassociated pneumonia in patients with liver transplantation.Method1.The possible risk factors of ventilator-associated pneumonia in patients with liver transplantation were preliminarily selected by consulting literature and medical staff of liver transplantation department.The clinical data were collected by the checklist of ventilator-associated prevention in patients with liver transplantation and reviewing the medical records of patients with liver transplantation.According to the diagnostic criteria of the American Centers For Disease Control and prevention for ventilator-associated pneumonia,the patients were divided into infection group and non-infection group.Single factor ?2test and multi factor Logistic regression analysis were used to select the independent risk factors of ventilator-associated pneumonia in patients with liver transplantation.2.According to the checklist of ventilator-associated prevention in patients with liver transplantation completed by the department of liver transplantation,the measures and the overall implementation of the cluster intervention strategy were analyzed retrospectively,the compliance of clinical medical staff to the cluster intervention strategy was calculated,and the shortcomings of the cluster intervention strategy in the clinical implementation process were found out.?2 test was used to analyze the relationship between the compliance of each measure of the cluster intervention strategy and ventilator-associated pneumonia,and to verify whether the current cluster intervention strategy can reduce the incidence of ventilator-associated pneumonia in patients with liver transplantation.3.The first draft of the cluster intervention strategy was determined by combining the effective measures of reducing the incidence of ventilator-associated pneumonia in liver transplantation patients with the measures recommended in the guidelines of preventing ventilator-associated pneumonia at home and abroad.Based on the method of multi-criteria decision analysis,the researcher designs the questionnaire of expert consultation and carries out two rounds of expert consultation after pre investigation.According to the average value of each expert's score on the importance of the criteria,the weight value of each criterion of the multi-criteria decision analysis is calculated.Then,the weight value is multiplied by the average score of each expert's score of each preventive measure of ventilator-associated pneumonia.Finally,the top five items with the highest score value are taken the measures constitute a centralized intervention strategy and formulate corresponding implementation rules.Results1.The results of single factor analysis of risk factors of ventilator-associated pneumonia in patients with liver transplantation showed that: age ? 65 years old,state of consciousness,smoking history,previous chronic obstructive pulmonary disease,operation time,mechanical ventilation time,continuous aspiration of subglottic secretions,effective management of ventilator,Intensive Care Unit stay time,and ventilatorassociated pneumonia cluster intervention strategy were all in accordance with a total of10 factors(P<0.05).There was no significant difference in gender and enteral nutrition between patients with liver transplantation(P>0.05).All 12 influencing factors were used as independent variables for multivariate logistic analysis.Finally,four variables(cluster intervention strategy was not followed,non-continuous aspiration of subglottic secretions,smoking history,age ? 65 years old)were obtained,indicating that the four variables were ventilator-associated pneumonia in patients with liver transplantation Significant influencing factors(P<0.05).2.Among the five measures of the cluster intervention strategy,the compliance of four measures,i.e.no special contraindications to raise the head of the bed 30 ~45,daily wake-up and extubation evaluation,oral care,and prevention of stress ulcer in the digestive tract,can affect the incidence of ventilator-associated pneumonia in patients with liver transplantation(P<0.05),and the prevention of deep vein thrombosis in the lower limbs has no effect on the incidence of ventilator-associated pneumonia in patients with liver transplantation.According to the above order,the medical staff the compliance of each measure was 53.5%,88.1%,76.2%,96.8% and 98.4%.3.The results of multi-criteria decision analysis showed that there are five measures suitable for the cluster intervention strategy: daily wake-up and extubation evaluation;strict hand hygiene;no special contraindications to raise the head of the bed 30 ~45;oral care;continuous aspiration of subglottic secretions.ConclusionThe incidence of ventilator-associated pneumonia in patients with liver transplantation is the result of the comprehensive effect of the patient's internal environment and various factors,in which the failure of the cluster intervention strategy has a significant impact on the incidence of ventilator-associated pneumonia.In clinical work,the compliance of medical staff to the five measures of cluster intervention strategy is not the same.Among them,the compliance of no special contraindications to raise the head of the bed 30 ~45,daily wake-up and extubation evaluation,oral care is not up to the standard(< 95%),and the clinical effectiveness of preventing the formation of lower extremity deep vein thrombosis needs further demonstration(P>0.05).The multi-criteria decision analysis method is used to optimize the cluster intervention strategy to prevent the occurrence of ventilator-associated pneumonia in liver transplantation patients,which is conducive to improving the compliance of medical staff to the guidelines and reducing the incidence of ventilator-associated pneumonia in patients with liver transplantation.