The Role of Maintaining Constant Pressure of the Endotracheal Catheter Cuff in Prevention of Ventilator-associated Pneumonia_West China Medical Journal

Authors：

 ZhuMinghua ¹ , QiuZhihong ² , LiuHua ¹ , NaYiwen ¹ , LiHong ² , LiuYingjie ³ , MiaoQin ¹ , HeJingzhi ¹ , DaiKunpeng ¹ ,  LiuHaitao ¹

1. Department of Nosocomial Infection Management;North China Petroleum Bureau General Hospital Affiliated to Hebei Medical University, Renqiu, Hebei 062552, P. R. China;
2. Department of Respiratory Medicine;North China Petroleum Bureau General Hospital Affiliated to Hebei Medical University, Renqiu, Hebei 062552, P. R. China;
3. Department of Medical Equipment;North China Petroleum Bureau General Hospital Affiliated to Hebei Medical University, Renqiu, Hebei 062552, P. R. China;

Corresponding?author：

LiuHaitao, Email: 18632738079@126.com

Keywords：

Pressure gauges; Cluster management; Endotracheal catheter cuff pressure; Ventilator-associated pneumonia

DOI：

10.7507/1002-0179.201600115

Video：

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Objective To explore the preventive role of maintaining constant pressure of the endotracheal catheter cuff on ventilator-associated pneumonia (VAP). Methods From January to December 2015, 96 patients of type Ⅱ respiratory failure were selected as the trial group who underwent intubation and mechanical ventilation more than 48 hours in the Intensive Care Unit (ICU). We used pressure gauges to measure the endotracheal catheter cuff pressure regularly and maintained a constant pressure in addition to the application of artificial airway cluster management. We recorded the initial pressure value which was estimated by pinching with finger and set initial pressure to 30 cm H₂O (1 cm H₂O=0.098 kPa). We measured endotracheal catheter cuff pressure and recorded it during different intervals. We reviewed 88 patients with the same disease as the control group who only accepted artificial airway cluster management between January and December 2014. Mechanical ventilation time, VAP occurrence time, ICU admission time, the incidence of VAP were recorded and analyzed for both the two groups of patients. Results In the trial group, the initial pressure of endotracheal catheter cuff which was estimated by pinching with finger showed that only 11.46% of pressure was between 25 and 30 cm H₂O and 82.29% of the pressure was higher than 30 cm H₂O. We collected endotracheal catheter cuff pressure values during different interval time by using pressure gauges to maintain a constant management. The ratio at the pressure between 25 and 30 cm H₂O was respectively 41.32%, 43.75%, 64.20%, 76.54%, 91.13%, and 91.85%. ICU admission time, mechanical ventilation time in patients of the trial group decreased more, compared with the control group, and the differences were statistically significant (t=4.171, P<0.001; t=4.061, P<0.001). The VAP occurrence time in patients of the trial group was later than the control group (t=2.247, P<0.001). Conclusion The endotracheal catheter cuff pressure estimated by pinching with finger has errors. We recommend using pressure gauges to detect pressure every four hours, which utilizes minimal time to maintain effective pressure. The method of artificial airway of cluster management combined with the pattern of maintaining constant endotracheal catheter cuff pressure can shorten ICU admission time, mechanical ventilation time and delay the occurrence of VAP.

Citation： ZhuMinghua, QiuZhihong, LiuHua, NaYiwen, LiHong, LiuYingjie, MiaoQin, HeJingzhi, DaiKunpeng, LiuHaitao. The Role of Maintaining Constant Pressure of the Endotracheal Catheter Cuff in Prevention of Ventilator-associated Pneumonia. West China Medical Journal, 2016, 31(3): 422-426. doi: 10.7507/1002-0179.201600115 Copy

1.	孫彩霞. ICU呼吸機相關性肺炎的原因分析及護理對策[J]. 中華醫院感染學雜志, 2013, 23(5):1007-1009.
2.	李軍, 李素玲, 韓軍. 氣流沖擊法清除氣囊上滯留物對氣管插管患者預防呼吸機相關性肺炎的效果評價[J]. 中國實用護理雜志, 2012, 28(36):45-46.
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9.	中華醫學會呼吸病分會呼吸治療學組. 人工氣道氣囊的管理專家共識[J]. 中華結核和呼吸雜志, 2014, 37(11):816-819.
10.	中華醫學會重癥醫學分會. 呼吸機相關性肺炎預防、診斷及治療指南(2013)[J]. 中華內科雜志, 2013, 52(6):1-20.
11.	張長春, 賈曉君, 王萍, 等. ICU呼吸機相關性肺炎病原菌構成及耐藥性分析[J]. 中華醫院感染學雜志, 2014, 24(1):47-49.
12.	Joseph NM, Sistla S, Dutta TK, et al. Ventilator-associated pneumonia:a review[J]. Eur J Intern Med, 2010, 21(5):360-368.
13.	Restrepo MI, Anzueto A, Arroliga AC, et al. Economic burden of ventilator-associated pneumonia based on total resource utilization[J]. Infect Control Hosp Epidemiol, 2010, 31(5):509-515.
14.	Rello J, Ollendorf DA, Oster G, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database[J]. Chest, 2002, 122(6):2115-2121.
15.	Sole ML, Penoyer DA, Su X, et al. Assessment of endotracheal cuff pressure by continuous monitoring:a pilot study[J]. Am J Crit Care, 2009, 18(2):133-143.
16.	李金芳, 邵芹, 王正梅, 等. 兩種氣囊壓力檢測方法預防呼吸機相關性肺炎的效果比較[J]. 中華現代護理雜志, 2012, 18(30):3697-3698.
17.	付優, 席修明. 機械通氣患者低氣囊壓力的影響因素分析[J]. 中華危重病急救醫學, 2014, 26(12):870-874.
18.	Rello J, So?ora R, Jubert P, et al. Pneumonia in intubated patients:role of respiratory airway care[J]. Am J Respir Crit Care Med, 1996, 154(1):111-115.

1. 孫彩霞. ICU呼吸機相關性肺炎的原因分析及護理對策[J]. 中華醫院感染學雜志, 2013, 23(5):1007-1009.
2. 李軍, 李素玲, 韓軍. 氣流沖擊法清除氣囊上滯留物對氣管插管患者預防呼吸機相關性肺炎的效果評價[J]. 中國實用護理雜志, 2012, 28(36):45-46.
3. 杜志強, 施青山, 李鳳詩. 氣囊上滯留物引流對呼吸機相關性肺炎的影響及致病菌分析[J]. 檢驗醫學與臨床, 2014, 11(4):465-467.
4. 中華醫學會重癥醫學分會. 機械通氣臨床應用指南(2006)[J]. 中國危重病急救醫學, 2007, 19(2):65-72.
5. Augustyn B. Ventilator-associated pneumonia:risk factors and prevention[J]. Crit Care Nurse, 2007, 27(4):32.
6. 劉竹, 黃瓊華, 安寒, 等. 重癥監護病房呼吸機相關肺炎的集束干預效果觀察[J]. 華西醫學, 2014, 29(3):449-451.
7. 李麗華, 王麗. 綜合ICU呼吸機相關性肺炎的預防及護理措施[J]. 華西醫學, 2010, 25(9):1745-1746.
8. 王崢, 張連心. 重癥監護室發生呼吸機相關性肺炎的相關危險因素及對策分析[J]. 中外醫學研究, 2015, 13(6):31-32.
9. 中華醫學會呼吸病分會呼吸治療學組. 人工氣道氣囊的管理專家共識[J]. 中華結核和呼吸雜志, 2014, 37(11):816-819.
10. 中華醫學會重癥醫學分會. 呼吸機相關性肺炎預防、診斷及治療指南(2013)[J]. 中華內科雜志, 2013, 52(6):1-20.
11. 張長春, 賈曉君, 王萍, 等. ICU呼吸機相關性肺炎病原菌構成及耐藥性分析[J]. 中華醫院感染學雜志, 2014, 24(1):47-49.
12. Joseph NM, Sistla S, Dutta TK, et al. Ventilator-associated pneumonia:a review[J]. Eur J Intern Med, 2010, 21(5):360-368.
13. Restrepo MI, Anzueto A, Arroliga AC, et al. Economic burden of ventilator-associated pneumonia based on total resource utilization[J]. Infect Control Hosp Epidemiol, 2010, 31(5):509-515.
14. Rello J, Ollendorf DA, Oster G, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database[J]. Chest, 2002, 122(6):2115-2121.
15. Sole ML, Penoyer DA, Su X, et al. Assessment of endotracheal cuff pressure by continuous monitoring:a pilot study[J]. Am J Crit Care, 2009, 18(2):133-143.
16. 李金芳, 邵芹, 王正梅, 等. 兩種氣囊壓力檢測方法預防呼吸機相關性肺炎的效果比較[J]. 中華現代護理雜志, 2012, 18(30):3697-3698.
17. 付優, 席修明. 機械通氣患者低氣囊壓力的影響因素分析[J]. 中華危重病急救醫學, 2014, 26(12):870-874.
18. Rello J, So?ora R, Jubert P, et al. Pneumonia in intubated patients:role of respiratory airway care[J]. Am J Respir Crit Care Med, 1996, 154(1):111-115.

West China Medical Journal

The Role of Maintaining Constant Pressure of the Endotracheal Catheter Cuff in Prevention of Ventilator-associated Pneumonia

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