St Vincent's Hospital, Sydney, Australia; Discipline of Physiotherapy Graduate School of Health, The University of Technology Sydney, Australia.
Critical Care and Trauma Division, The George Institute for Global Health, Australia; Sydney Medical School, University of Sydney, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Australia.
Aust Crit Care. 2018 Jul;31(4):191-196. doi: 10.1016/j.aucc.2017.06.002. Epub 2017 Jun 27.
INTRODUCTION/AIMS: To describe the processes of care for secretion clearance in adult, intubated and mechanically ventilated patients in Australian and New Zealand Intensive Care Units (ICUs).
METHODS/RESULTS: A prospective, cross-sectional study was conducted through the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS CTG) Point Prevalence Program. Forty-seven ICUs collected data from 230 patients intubated and ventilated on the study day. Secretion clearance techniques beyond standard suctioning were used in 84/230 (37%) of patients during the study period. Chest wall vibration 34/84 (40%), manual lung hyperinflation 24/84 (29%), chest wall percussion 20/84 (24%), postural drainage/patient positioning 17/84 (20%) and other techniques including mobilisation 15/84 (18%), were the most common secretion clearance techniques employed. On average (SD), patients received airway suctioning 8.8 (5.0) times during the 24-h study period. Mucus plugging events were infrequent (2.7%). The additional secretion clearance techniques were provided by physiotherapy staff in 24/47 (51%) ICUs and by both nursing and physiotherapy staff in the remaining 23/47 (49%) ICUs.
One-third of intubated and ventilated patients received additional secretion clearance techniques. Mucus plugging events were infrequent with these additional secretion clearance approaches. Prospective studies must examine additional secretion clearance practices, prevalence of mucus plugging episodes and impact on patient outcomes.
介绍/目的：描述澳大利亚和新西兰重症监护病房（ICU）中成年、插管和机械通气患者清除分泌物的护理过程。
方法/结果：通过澳大利亚和新西兰重症监护学会临床试验组（ANZICS CTG）进行了一项前瞻性、横断面研究点患病率计划。47 个 ICU 在研究日从 230 名插管和通气的患者中收集数据。在研究期间，有 84/230（37%）的患者使用了标准吸痰以外的分泌物清除技术。在 84/84（40%）的患者中使用了胸壁振动、24/84（29%）手动肺充气、20/84（24%）胸壁叩击、17/84（20%）体位引流/患者定位和其他技术，包括 15/84（18%）的动员。平均（SD），患者在 24 小时研究期间接受气道吸痰 8.8（5.0）次。黏液栓事件很少见（2.7%）。额外的分泌物清除技术由物理治疗师在 24/47（51%）的 ICU 中提供，由护理和物理治疗师在其余 23/47（49%）的 ICU 中提供。
三分之一的插管和通气患者接受了额外的分泌物清除技术。使用这些额外的分泌物清除方法，黏液栓事件很少见。必须进行前瞻性研究，以检查额外的分泌物清除方法、黏液栓事件的发生率以及对患者结局的影响。
