| Objective:1:To evaluate the effects of Comprehensive management measures on patients with mechanical ventilation in emergency intensive care unit (EICU).2:To explore the effects of replacing frequency of the different endotracheal tubes on the endotracheal tube bacteria colonization in patients with mechanical ventilation based on the management of comprehensive nursing measures.Methods:Collected the clinical data of mechanical ventilation patients who were treated in EICU during July 2014 to September 2016. Compare the airway nursing quality of EICU patients in our hospital before and after the implementation of the comprehensive nursing measures. The patients collected in our EICU from July 2014 to June 2015 wihtout implementation of the Comprehensive management measures Comprehensive management measures was acted as the control group, and the patients collected from July 2015 to June 2016 within the implementation of Comprehensive management measures acted as the observation group. Then collected the data of these two group, and compared the adverse events, pathogen detection, VAP occurrence, hospitalization time and cost of patients in these two groups. A prospective, randomized, controlled design was used to study the management of tracheotomy patients with mechanical ventilation from July 2015 to September 2016. These patients were divided into 7 days and 14 days to to replace the endotracheal tube respectively. The lower respiratory tract secretions (sputum) culture, endotracheal tube wall bacterial culture and drug sensitivity test were performed in these two group patients, and the compared the microbes colonization of tracheal catheter, the incidence rate of VAP, hospitalization time, total hospitalization expenses, duration of mechanical ventilation, prognosis in these two groups.Results:(1) A total of 314 patients with mechanical ventilation were included in this study on the application of Comprehensive management measures in patients with mechanical ventilation in EICU.151 cases were collected in the control group, and 163 cases were collected in the observation group. The average age of the two groups is 42.4+13.6 and 43.2+14.3 years old, and the proportions of male patients in these two groups were 86 (56.95%) and 91 (55.83%) cases. The APACHE score is 16.7+ 2.7 and 16.2+2.3 points, and proportion of delirium 83 (54.97%) and 91 (55.83%) cases in these two groups. The difference was not statistically significance (p>0.05) compared with the baseline data. The continuous quality improvement checklist scores were 81±4.5 and 93±2.7 points respectively in these two groups. The unstandardized operation, the implementation leakage, the inaccurate assessment, the handover error or omission, the numbers of examinations were not done in tim in the observation group are less than the control group, and the difference was statistically significantly (p<0.05). The accidental extubation times (including non tracheal catheter) were 35 and 9 times, the endotracheal tube plugging cases were 13 and 2 times respectively in the control group and the observation group. The incidence of adverse events in the observation group was significantly decreased, there is statistical significance (p<0.05). The positive rate of pathogen detection were 97 (64.24%) and 58 (35.58%) cases, and the incidence rate of VAP was 65 (43.05%) and 17 (10.43%) cases respectively in the control group and the observation group. These data in observation group was decreased significantly compared with control group, there is statistical significance (p<0.05). The mechanical ventilation time was 10.6±2.1 and 18.3±1.3 days (t=7.30,.p<0.05), the hospitalization time was 14.6±3.3 and 11.5±1.7 days (t=10.57,p<0.05), cost of hospitalization was 11.4±3.5 and 8.7±2.3 ten thousand yuan (t=8.13, p<0.05) respectively in the control group and the observation group. There is statistical significance of all these data in observation group compared with control group (p<0.05). The MV time of observation group, hospitalization time was decreased, the cost of hospitalization was reduced, with statistical significance.(2) A total of 218 tracheotomy patients were enrolled in this study. Among them 110 cases of replacing the endotracheal tube on 7 day,108 cases of replacing the endotracheal tube on 14 day. A total of 218 cases of tracheotomy patients with mechanical ventilation performed with comprehensive nursing management measures were enrolled in the study of the effects of different replacement frequency of tracheal catheter on tracheal catheter colonization. Among them 110 cases of replacing the endotracheal tube on 7 day,108 cases of replacing the endotracheal tube on 14 day. ETT tube wall culture showed positive of 175 cases in 218 patients (80.28%), sputum culture showed positive of 85 cases (38.99%), moreover the results of bacteria culture and ETT tube wall bacteria culture have the same number of cases is 75 cases. In these results of bacteria culture, the ETT tube wall culture in 7 day group is 72 cases (65.45%), sputum culture is 36 cases (32.72%), the same number of cases is 27 cases (75%); however, the results in 14 day group showed 103 cases (95.37%),49 cases (45.73%),48 cases (97.96%) respectively. The rate of bacteria colonization of the catheter and the positive rate of sputum culture in observation group was lower than in control group. The results showed the significantly difference in observation group compared with control group (p< 0.05).(3) The results showed that the incidence rate of VAP, hospitalization expenses, hospitalization time and mechanical ventilation (MV) time in observation group was declined signifiantly compared with control group, which showed significantly different (p<0.05). However, the mortality rate of observation group was declined, there is no significant difference (p>0.05).Conclusion:(1) Through the establishment of Comprehensive management measures can significantly improve the quality of risk management in patients with mechanical ventilation, reduce adverse events in patients with mechanical ventilation and the incidence rate of VAP, reduce hospitalization time and cost, and improve the prognosis of patients. (2) The incidence rate of microbes colonization incidence rate of VAP, mechanical ventilation time, hospitalization expenses and hospitalization time was significantly decreased in patients with replacing the endotracheal tube on 7 day compared with those patients with replacing the endotracheal tube on 14 days after the management with Comprehensive management measures based on the use of disposable tracheal catheter. The results indicated that the tracheal catheter was replaced on 7 day is recommended. |
PDF Full Text Request