Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA.
J Crit Care. 2011 Jun;26(3):280-6. doi: 10.1016/j.jcrc.2010.05.035. Epub 2010 Jul 23.
The aim of this study was to determine whether the use of a polyurethane-cuffed endotracheal tube would result in a decrease in ventilator-associated pneumonia rate.
We replaced conventional endotracheal tube with a polyurethane-cuff endotracheal tube (Microcuff, Kimberly-Clark Corporation, Rosewell, Ga) in all adult mechanically ventilated patients throughout our large academic hospital from July 2007 to June 2008. We retrospectively compared the rates of ventilator-associated pneumonia before, during, and after the intervention year by interrupted time-series analysis.
Ventilator-associated pneumonia rates decreased from 5.3 per 1000 ventilator days before the use of the polyurethane-cuffed endotracheal tube to 2.8 per 1000 ventilator days during the intervention year (P = .0138). During the first 3 months after return to conventional tubes, the rate of ventilator-associated pneumonia was 3.5/1000 ventilator days. Use of the polyurethane-cuffed endotracheal tube was associated with an incidence risk ratio of ventilator-associated pneumonia of 0.572 (95% confidence interval, 0.340-0.963). In statistical regression analysis controlling for other possible alterations in the hospital environment, as measured by rate of tracheostomy-ventilator-associated pneumonia, the incidence risk ratio of ventilator-associated pneumonia in patients intubated with polyurethane-cuffed endotracheal tube was 0.565 (P = .032; 95% confidence interval, 0.335-0.953).
Use of a polyurethane-cuffed endotracheal tube was associated with a significant decrease in the rate of ventilator-associated pneumonia in our study.
本研究旨在确定使用聚氨酯套囊气管导管是否会降低呼吸机相关性肺炎的发生率。
我们在 2007 年 7 月至 2008 年 6 月期间，在我院所有成人机械通气患者中，将常规气管导管更换为聚氨酯套囊气管导管（Microcuff，Kimberly-Clark Corporation，Rosewell，Ga）。通过中断时间序列分析，回顾性比较干预年前、干预年中和干预年后呼吸机相关性肺炎的发生率。
使用聚氨酯套囊气管导管前，呼吸机相关性肺炎的发生率为每千通气日 5.3 例，干预年期间为每千通气日 2.8 例（P =.0138）。在回归常规导管后的前 3 个月，呼吸机相关性肺炎的发生率为每千通气日 3.5 例。使用聚氨酯套囊气管导管与呼吸机相关性肺炎的发病风险比为 0.572（95%置信区间，0.340-0.963）。在控制医院环境中其他可能变化的统计回归分析中，以气管切开-呼吸机相关性肺炎的发生率来衡量，使用聚氨酯套囊气管导管的患者呼吸机相关性肺炎的发病风险比为 0.565（P =.032；95%置信区间，0.335-0.953）。
在本研究中，使用聚氨酯套囊气管导管与呼吸机相关性肺炎发生率的显著降低相关。
