Application Of Oral Irrigation Combined With Intermittent Subglottic Lavage In ICU Patients With Tracheal Intubation

Research Purpose:The purpose of this study was to investigate the clinical application of oral irrigation combined with intermittent subglottic irrigation in patients with ICU transoral tracheal intubation and parallel mechanical ventilation,aiming to provide a reference for reducing the incidence of ventilator-associated pneumonia（VAP）in patients,shortening the duration of mechanical ventilation（MV）and ICU stay,with the aim of improving the prognosis of patients.Research Methods:This is an experimental study,and patients who underwent transoral tracheal intubation with MV in the intensive care medicine department of a tertiary care hospital in Zhejiang Province from January 2021 to December were selected as the study population.Eighty-two patients who met the inclusion criteria were included in the study,and they were randomly divided into a control group and an experimental group,with 41 cases in each group.A total of three patients were eventually excluded from the experimental group because the intervention time was not completed（<7 days）,and one patient was excluded from the control group because the intervention time was not completed and one patient died.77 patients were finally included in the study,39 in the control group and 38 in the experimental group.Patients in both groups received general care measures during their ICU stay.Oral irrigation was performed every 8 hours in the control group,and intermittent subglottic irrigation was used in the experimental group in addition to the control group.The APACHE-II score and SOFA score were performed on days 1,3 and 6（i.e.,days 2,4 and 7 of intubation）,and the subglottic-supraglottic lavage and lower airway secretions were retained for pathogenic bacteria testing after oral cleaning on the morning of days1,3 and 6 of the intervention.The incidence of VAP,the results of subglottic-supraglottic retention and lower respiratory secretion pathogen detection,MV time,ICU stay,APACHE-II score and SOFA score were compared between the two groups.SPSS 25.0 software was used for statistical analysis of the data,and the count data were expressed as frequency and frequency,and the measurement data were expressed as（?）±S if they were normally distributed,and the skewed distribution was expressed as M(P₂₅,P₇₅).The（?）~2test or Fisher’s exact probability method was used for the comparison of count data,and the two independent samples t test was used for the comparison between groups of measurement data that obeyed normal distribution with chi-square,and the nonparametric rank sum test was used for the comparison between groups of non-normally distributed measurement data,and the generalized estimating equation was used for the effect analysis,and the difference was considered statistically significant at P<0.05.Research Results:（1）On the comparison of the incidence of VAP:a total of 9 patients in the control group had VAP,with an incidence of 23%,and 2 patients in the experimental group had VAP,with an incidence of5.3%.Compared with the control group,the incidence rate of the experimental group was significantly lower,and the difference was statistically significant（P<0.05）.（2）In the comparison of pathogenic bacteria detection results:104 pathogenic bacteria were detected in the subsonic-supraglottic retention in the control group,and 77 pathogenic bacteria were detected in the experimental group;93 pathogenic bacteria were detected in the lower respiratory secretion in the control group,and 70 pathogenic bacteria were detected in the experimental group,and the distribution and composition of the flora were similar in both groups,with G-predominant,and the differences were not statistically significant（P>0.05）.（3）In the comparison of the pathogenic bacteria compliance rate:the compliance rate between subglottic-supraglottic stagnant and lower respiratory secretion pathogens was 55.6%in the control group of VAP patients and 50.0%in the experimental group,with a mean compliance rate of 54.6%.（4）On the comparison of MV time and ICU stay:MV time:9（8,14）days in the control group and8（7,11）days in the experimental group,with no statistically significant difference（P>0.05）;ICU stay:18（9,29）days in the control group and 13.5（9,18.25）days in the experimental group,with statistically significant difference（P<0.05）.（5）On the comparison of APACHE-II score and SOFA score:APACHE-II score:there was a between-group effect and time effect,and the difference was statistically significant（P<0.05）,and there was no interaction effect between between-group effect and time effect（P>0.05）;SOFA score:there was no statistically significant main effect of between-group effect on SOFA score between the two groups（P>0.05）The main effect of time effect on SOFA scores before and after the intervention was significant in both groups（P<0.05）,and there was no interaction between the between-group effect and the time effect（P>0.05）.Research Conclusion:（1）Oral irrigation combined with intermittent subglottic irrigation can effectively remove the residues on the oral cavity and subglottic-air sac,reduce the chance of bacterial migration and colonization in the lower airways and lungs,and effectively block the infection pathway of VAP.（2）The distribution and composition of pathogenic bacteria in the two groups were similar,mainly G-,and the pathogenic bacteria match rate of the two groups of VAP patients was as high as 54.6%,indicating that the occurrence of VAP may be related to the fall of the subglottis-air sac lagging into the lower respiratory tract.（3）Oral irrigation combined with intermittent subglottic irrigation can effectively shorten the ICU stay of patients without increasing the MV time,which can improve the prognosis to some extent.