Al Dorzi Hasan M, Ghanem Alaaeldien G, Hegazy Mohamed Moneer, AlMatrood Amal, Alchin John, Mutairi Mohammed, Aqeil Ahmad, Arabi Yaseen M
Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
Ann Thorac Med. 2022 Jan-Mar;17(1):37-43. doi: 10.4103/atm.atm_135_21. Epub 2022 Jan 14.
Endotracheal tube (ETT) occlusion is a potentially life-threatening event. This study describes a quality improvement project to prevent ETT occlusion in critically ill patients.
After a cluster of clinically significant ETT occlusion incidents at a tertiary-care intensive care unit (ICU), the root cause analysis suggested that the universal use of heat moisture exchangers (HMEs) was a major cause. Then, we prospectively audited new ETT occlusion incidents after changing our practices to evidence-based active and passive humidification during mechanical ventilation (MV). We also compared the outcomes of affected patients with matched controls.
During 100 weeks, 18 incidents of clinically significant ETT occlusion occurred on a median of 7 days after intubation (interquartile range, 4.8-9.5): 8 in the 10 weeks before and 10 in the 90 weeks after changing humidification practices (8.1 vs. 1.0 incidents per 1000 ventilator days, respectively). The incidents were not suspected in 94.4%, the peak airway pressure was >30 cm HO in only 25%, and 55.6% were being treated for pneumonia when ETT occlusion occurred. Compared with 51 matched controls, ETT occlusion cases had significantly longer MV duration (median of 13.5 vs. 4.0 days; = 0.002) and ICU stay (median of 26.5 vs. 11.0 days; = 0.006) and more tracheostomy (55.6% vs. 9.8%; < 0.001). The hospital mortality was similar in cases and controls.
The rate of ETT occlusion decreased after changing humidification practices from universal HME use to evidence-based active and passive humidification. ETT occlusion was associated with more tracheostomy and a longer duration of MV and ICU stay.
气管内插管（ETT）堵塞是一种可能危及生命的事件。本研究描述了一项旨在预防重症患者ETT堵塞的质量改进项目。
在一家三级医疗重症监护病房（ICU）发生一系列具有临床意义的ETT堵塞事件后，根本原因分析表明，普遍使用热湿交换器（HME）是主要原因。然后，在我们将机械通气（MV）期间的做法改为基于证据的主动和被动加湿后，我们前瞻性地审核了新的ETT堵塞事件。我们还将受影响患者的结果与匹配的对照组进行了比较。
在100周内，发生了18起具有临床意义的ETT堵塞事件，插管后中位时间为7天（四分位间距，4.8 - 9.5）：在改变加湿做法前的10周内有8起，改变后90周内有10起（分别为每1000呼吸机日8.1起和1.0起事件）。94.4%的事件未被怀疑，仅25%的事件气道峰值压力>30 cm H₂O，55.6%的事件在ETT堵塞发生时正在接受肺炎治疗。与51名匹配的对照组相比，ETT堵塞病例的MV持续时间显著更长（中位时间为13.5天对4.0天；P = 0.002），ICU住院时间也更长（中位时间为26.5天对11.0天；P = 0.006），气管切开术更多（55.6%对9.8%；P < 0.001）。病例组和对照组的医院死亡率相似。
将加湿做法从普遍使用HME改为基于证据的主动和被动加湿后，ETT堵塞率降低。ETT堵塞与更多的气管切开术以及更长的MV和ICU住院时间相关。
