Weston Smith Nicholas, Spivey Michael
Department of Anaesthesia, Royal Cornwall Hospitals NHS Trust, Truro, UK
Department of Critical Care, Royal Cornwall Hospitals NHS Trust, Truro, UK.
BMJ Open Qual. 2021 May;10(2). doi: 10.1136/bmjoq-2020-001269.
The aim of the study was to promote the practice of subglottic secretion drainage (SSD) in a UK critical care unit. SSD is a technique employed to reduce microaspiration of oropharyngeal secretions in patients with cuffed endotracheal airways. Aspiration of oropharyngeal secretions is the accepted cause of the majority of ventilator-associated pneumonia (VAP), a complication of invasive ventilation with high associated mortality. The plan-do-study-act methodology was employed. The local critical care patient database was searched for patients requiring mechanical ventilation via a tracheostomy tube with subglottic port in the 3 months prior to intervention. Patient records were interrogated for evidence of the practice of SSD. The intervention involved the introduction of a tracheostomy care bundle to be prescribed on insertion of a tracheostomy on the critical care unit, in combination with departmental teaching. The bundle included prompts for nursing staff to practise regular SSD and to complete a tracheostomy care plan at the end of shift. A total of 24 patients were included. A review of practice was conducted every 3 months for 1 year. This showed an improvement in documented evidence of SSD from 0% of days at baseline to 85.7% of days at 1 year. Implementation of a tracheostomy order set prescribing regular SSD resulted in an improvement in the practice of SSD in patients ventilated via tracheostomy. This has implications for patient outcomes and healthcare costs, given that SSD has been shown to reduce incidence of VAP.
该研究的目的是在英国一家重症监护病房推广声门下分泌物引流（SSD）的做法。SSD是一种用于减少带套囊气管内插管患者口咽分泌物微误吸的技术。口咽分泌物误吸是大多数呼吸机相关性肺炎（VAP）公认的病因，VAP是有创通气的一种并发症，相关死亡率很高。采用了计划-实施-研究-改进方法。在干预前3个月，在当地重症监护患者数据库中搜索需要通过带声门下端口的气管造口管进行机械通气的患者。查阅患者记录以寻找SSD做法的证据。干预措施包括在重症监护病房插入气管造口管时引入一份气管造口护理包，并结合科室教学。该护理包包括提示护理人员定期进行SSD，并在轮班结束时完成气管造口护理计划。共纳入24例患者。在1年的时间里，每3个月对实践情况进行一次评估。结果显示，记录在案的SSD证据从基线时的0%提高到1年时的85.7%。实施规定定期进行SSD的气管造口医嘱集可改善通过气管造口进行通气患者的SSD实践情况。鉴于SSD已被证明可降低VAP的发生率，这对患者预后和医疗成本具有影响。
