建立ICU呼吸专科护理小组在机械通气病人中的作用

The Role of the ICU Ventilator Specialist Care Team in Mechanically Ventilated Patients

目的:探讨建立ICU呼吸专科护理小组在机械通气病人中的作用。方法:评估建立ICU呼吸专科护理小组前后实施呼吸机集束策略依从性的情况及对呼吸机相关性肺炎(VAP)发生率的影响。结果:建立ICU呼吸专科护理小组前后分别纳入458、487个病人,手卫生依从性由20.9%提高到65.7%(P=0.001);床头抬高30°以上依从性由24.8%提高到49.5%(P=0.001);镇静评分依从性无明显改善(P=0.06);使用无创呼吸机依从性由20.4%提高到32%(P=0.03)。同时ICU呼吸专科护理小组建立后可降低VAP发生率(24.4%vs 41.7%,P=0.004),降低VAP病人的机械通气时间和ICU住院时间,但并不能降低其死亡率。结论:建立ICU呼吸专科护理小组可提高呼吸机集束策略的依从性,可以降低VAP发生率。

Objective：To establish the role of the ICU ventilator specialist care team in mechanically ventilated patients. Methods： to evaluate the implementation of Ventilator dependence of the cluster strategy and the impact on the incidence of ventilator-associated pneumonia （VAP） before and after the establishment of the ICU ventilator specialist care team. Results：Before and after establishment of ICU ventilator specialist care team, there were respectively 458 and 487 patients included. Hand hygiene compliance increased from 20.9% to 65.7 % （P = 0.001）; compliance of bed head elevation more than 30° from 24.8% to 49.5% （P = 0.001）; compliance of sedation score was not improved significantly （P = 0.06）; Use ofnon-invasive ventilator compliance increased from 20.4% to 32% （P = 0.03）. Building oflCU ventilator specialist care team can reduce the incidence of VAP （24.4% vs 41.7%, P = 0.004）, reduce the duration of mechanical ventilation and ICU stay of VAP patients, but it does not reduce its mortality. Conclusion：ICU respiratory specialist care team can improve ventilator compliance of the cluster strategy and reduce the incidence of VAP.