气管导管固定装置的引入对重症监护病房口腔压力性损伤发生率及严重程度的影响：一项回顾性观察研究
Impact of the introduction of an endotracheal tube attachment device on the incidence and severity of oral pressure injuries in the intensive care unit: a retrospective observational study.
作者信息
Hampson Jaye, Green Cameron, Stewart Joanne, Armitstead Lauren, Degan Gemma, Aubrey Andrea, Paul Eldho, Tiruvoipati Ravindranath
机构信息
1Department of Intensive Care Medicine, Peninsula Health, Frankston Hospital, 2 Hastings road, Frankston, VIC 3199 Australia.
2Department of Epidemiology and Preventive Medicine, School of Public health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC Australia.
出版信息
BMC Nurs. 2018 Feb 8;17:4. doi: 10.1186/s12912-018-0274-2. eCollection 2018.
BACKGROUND
Endotracheal tube (ETT) fasteners such as the AnchorFast™ claim to assist with the prevention of oral pressure injuries in intubated patients, however evidence to support their clinical efficacy is limited. This retrospective observational study aimed to investigate the impact of the introduction of the AnchorFast™ device on the incidence of oral pressure injuries in mechanically ventilated patients.
METHODS
Data was collected from patient case notes and clinical incident reports for October 2010 to June 2013 ( and July 2013 to March 2016 (. Incidence and location of oral pressure injuries associated with securing device, and compliance with institutional policies related to reducing oral pressure injuries were recorded.
RESULTS
Incidence of oral pressure injuries increased from 1.53/100 intubated patients in the pre-AnchorFast period to 3.73/100 intubated patients in the post-AnchorFast period (IRR = 2.43, 95%CI = 1.35-4.38; = 0.003). Across both study periods, patients with an ETT secured using AnchorFast™ had significantly increased risk of oral pressure injuries (IRR = 2.03, 95%CI = 1.17-3.51; = 0.02). There was also a significant difference in location of pressure injuries sustained with ETTs secured using cloth tapes (53.6% in corner of the mouth) vs. AnchorFast™ (75% on the lips) ( = 0.008). Among patients with oral pressure injuries, compliance with institutional policies relating to the prevention of pressure injuries was significantly greater after the introduction of the AnchorFast™ (9.1% vs 64.5%, = 0.004).
CONCLUSIONS
The incidence of oral pressure injuries increased significantly following the introduction of the AnchorFast™ device. Further research is required to establish the reasons for this observed increase to and identify ways to reduce the risk of pressure injuries with ETT securement devices.
背景
气管内导管（ETT）固定器，如AnchorFast™，声称有助于预防插管患者的口腔压力性损伤，然而支持其临床疗效的证据有限。这项回顾性观察研究旨在调查引入AnchorFast™装置对机械通气患者口腔压力性损伤发生率的影响。
方法
收集2010年10月至2013年6月（以及2013年7月至2016年3月）患者病历和临床事件报告中的数据。记录与固定装置相关的口腔压力性损伤的发生率和位置，以及与减少口腔压力性损伤相关的机构政策的依从性。
结果
口腔压力性损伤的发生率从AnchorFast™使用前的每100例插管患者1.53例增加到使用后的每100例插管患者3.73例（发病率比值比[IRR]=2.43，95%置信区间[CI]=1.35-4.38；P=0.003）。在两个研究期间，使用AnchorFast™固定ETT的患者发生口腔压力性损伤的风险显著增加（IRR=2.03，95%CI=1.17-3.51；P=0.02）。使用布带固定ETT导致的压力性损伤位置（嘴角占53.6%）与使用AnchorFast™导致的压力性损伤位置（嘴唇占75%）也存在显著差异（P=0.008）。在发生口腔压力性损伤的患者中，引入AnchorFast™后，与预防压力性损伤相关的机构政策的依从性显著提高（9.1%对64.5%，P=0.004）。
结论
引入AnchorFast™装置后，口腔压力性损伤的发生率显著增加。需要进一步研究以确定观察到的这种增加的原因，并确定降低ETT固定装置导致压力性损伤风险的方法。
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