The Effect Of Intermittent Subglottic Secretion Irrigation Combined With Aspiration On VAP In Patients With Severe Neurological Disease

Background:Due to the influence of the disease,the patients with severe neurological disease need to establish artificial airway and ventilator-assisted ventilation treatment,and due to the decrease of consciousness level,dysphagia,decreased protective reflex,lower esophageal sphincter function,decreased cough reflex and other reasons,resulting in aspiration and pulmonary infection,they become the high-risk group of VAP.Subglottic secretion,as an important source of pathogenic bacteria,is the main factor inducing VAP.Effective drainage of subglottic secretion is an important means to prevent VAP.At present,the main methods of drainage of subglottic secretion which are widely used and recommended in clinic are intermittent subglottic secretion suction and intermittent subglottic secretion irrigation combined suction.The above two methods play an important role in the prevention of VAP,and have high operability.However,at present,there is a lack of comparison between the method of aspiration of discontinuous subglottic secretion and the method of combined aspiration of lavage.It is not clear which method is more effective and safer for the prevention of VAP.Objective:To explore the efficacy and safety of the method of intermittent subglottic secretion irrigation combined with suction in the prevention of VAP in patients with severe neurological diseases.Methods:The patients who were intubated and mechanically ventilated in the neurology intensive care unit of the first hospital of Jilin University since March 15,2019 were selected as the study objects.258 patients whose mechanical ventilation time was more than 72 h were randomly divided into control group and experimental group.All patients received routine nursing during the period of hospitalization in ICU,and implemented centralized intervention measures to prevent VAP.Subglottic secretion was aspirated every 4 hours in the control group,and subglottic secretion was aspirated every 4 hours in the test group.The incidence of VAP,the detection of pathogenic bacteria,the detection rate and coincidence rate of pathogenic bacteria in subglottic secretion and lower respiratory tract,the time of mechanical ventilation,the incidence of tube plugging in the accessory cavity(the drainage tube attached to the tracheal tube wall),the time of artificial airway retention were compared between the two groups.Results:(1)The incidence of VAP was 9.3% in the experimental group and 21.5% in the control group,which was significantly lower than that in the control group(P = 0.009);(2)In the control group,the detection rate of pathogenic bacteria was 56.3%,in the test group,the detection rate of pathogenic bacteria was 55.6%,there was no significant difference between the two groups(P = 0.87);in the control group,the detection rate of pathogenic bacteria in the lower respiratory tract was 16%;in the test group,the detection rate of pathogenic bacteria in the lower respiratory tract was 7.1%,and in the two groups,the detection rate of pathogenic bacteria in the lower respiratory tract was poor The difference was statistically significant(P < 0.001);the detection rate of gram-negative bacilli in the lower respiratory tract of the test group was 5.8%,which was significantly lower than that of the control group(13.5%);the difference was statistically significant(P = 0.001);the coincidence rate of pathogenic bacteria in the subglottic secretion of the test group with that of the lower respiratory tract was 3.5%,which was significantly lower than that of the control group(17.4%)(P < 0.0001).(3)The incidence of auxiliary cavity blockage in the experimental group was 0.6%,which was significantly lower than that of the control group(6.7%),and the difference was statistically significant(P<0.0001).(4)The average daily number of airway aspiration in the experimental group was 21(17,23),with no statistically significant difference compared with 21(17,24)in the control group(P=0.406).(5)The duration of mechanical ventilation in the experimental group was 9(7,11)d,which was statistically significant compared with the control group(10(8,12)d(P=0.019).(6)The artificial airway indwelling time in the experimental group was 11(8,13)d,compared with 12(9,14)d in the control group,the difference was not statistically significant(P=0.057).(7)The incidence of airway mucosal hemorrhage in the experimental group was 1.8%,with no statistically significant difference compared with 2.0% in the control group(P=0.804).(8)The rate of intubation within 24 hours after endotracheal extubation in the experimental group was 0.8%,compared with 0.8% in the control group.The difference was not statistically significant(P = 1.0).Conclusion:(1)The method of intermittent subglottic secretion irrigation combined with aspiration has better effect on the removal of subglottic secretion and effectively prevents the occurrence of VAP.(2)The method of intermittent subglottic secretion irrigation combined with suction dose not increase the risk of aspiration and cause additional damage to the airway mucosa of patients,and dose not increase the risk of intubation after extubation of patients' tracheal intubation,so it has better security.(3)Intermittent subglottic secretion irrigation combined with suction can shorten the time of mechanical ventilation,not increase the indwelling time of artificial airway,and may have a better effect on the prognosis of patients.