Combes P, Fauvage B, Oleyer C
Département d'Information Médicale et de Santé Publique, Centre Hospitalier de Roanne, France.
Intensive Care Med. 2000 Jul;26(7):878-82. doi: 10.1007/s001340051276.
To compare the ventilator-associated pneumonia (VAP) incidence rates in mechanically ventilated patients according to the type of endotracheal suctioning (closed versus open).
The Neurosurgery Intensive Care Unit of the Grenoble University Hospital, France.
A prospective randomised study performed after a 6-month period of nursing personnel training.
One hundred four consecutive patients needing mechanical ventilation for more than 48 h were randomised into two groups. To be eligible, patients had to have no active infection or respiratory affection in their passes. In the Stericath group (S+, n = 54), patients were not disconnected from the ventilator during suctioning. The others were routinely managed (S-, n = 50). In both groups patterns of frequency and duration of suctioning were performed according to a standardised protocol.
The non-adjusted incidence rate of VAP was lower for S+ than for S- (7.32 versus 15.89 per 1000 patient-days, p = 0.07). Multivariate analysis performed using the Cox model showed an adjusted risk of VAP 3.5 times higher in S- (95% CI: 11.00-12.33). The risk being 4.3 higher in patients receiving gastric acid secretion inhibitors (1.08-16.82). In non-censored cases (n = 76) length of ICU stay increased by an average of 16.8 days when VAP was present (p = 0.0008). No adverse effect due to Stericath use was noted and volume of tracheal aspirate was similar between groups (p = 0.178).
The use of Stericath reduced the incidence rate of VAP without demonstrating any adverse effect.
根据气管内吸痰方式（封闭式与开放式）比较机械通气患者的呼吸机相关性肺炎（VAP）发病率。
法国格勒诺布尔大学医院神经外科重症监护病房。
在为期6个月的护理人员培训后进行的一项前瞻性随机研究。
104例连续需要机械通气超过48小时的患者被随机分为两组。符合条件的患者在其过往病史中不得有活动性感染或呼吸道疾病。在Stericath组（S +，n = 54）中，患者在吸痰期间不与呼吸机断开连接。其他患者按常规处理（S -，n = 50）。两组均根据标准化方案进行吸痰频率和持续时间的模式操作。
S +组的VAP未调整发病率低于S -组（每1000患者日分别为7.32和15.89，p = 0.07）。使用Cox模型进行的多变量分析显示，S -组的VAP调整风险高3.5倍（95％CI：11.00 - 12.33）。接受胃酸分泌抑制剂的患者风险高4.3倍（1.08 - 16.82）。在非删失病例（n = 76）中，发生VAP时ICU住院时间平均增加16.8天（p = 0.0008）。未观察到使用Stericath的不良反应，两组之间气管吸出物量相似（p = 0.178）。
使用Stericath可降低VAP发病率，且未显示任何不良反应。
