预防策略的逐步实施及其对呼吸机相关性肺炎发病率的影响：一项为期13年的观察性监测研究。
Stepwise implementation of prevention strategies and their impact on ventilator-associated pneumonia incidence: A 13-Year observational surveillance study.
作者信息
Maertens Bert, Blot Stijn, Huis In 't Veld Diana, Blot Koen, Koch Annelies, Mignolet Katrien, Pannier Elise, Sarens Tom, Temmerman Werner, Swinnen Walter
机构信息
Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; UQ Centre for Clinical Research, The University of Queensland, Faculty of Medicine, Herston, Queensland, Australia.
出版信息
Intensive Crit Care Nurs. 2025 Feb;86:103769. doi: 10.1016/j.iccn.2024.103769. Epub 2024 Jul 22.
OBJECTIVE
To describe the practice of ventilator-associated pneumonia (VAP) prevention and control through the incremental introduction of prevention strategies and assess the effect on VAP incidence.
DESIGN
Historical observational surveillance study conducted over 13 years.
SETTING
A 12-bed adult intensive care unit (ICU) in a general hospital in Belgium.
PARTICIPANTS
Patients admitted between 2007 and 2019, with ICU stays of ≥48 h.
INTERVENTIONS
Incremental introduction of VAP preventive measures from 2008, including head-of-bed elevation, cuff pressure control, endotracheal tubes with tapered cuffs, subglottic secretion drainage, chlorhexidine oral care, and daily sedation assessment.
MEASUREMENTS AND MAIN RESULTS
A significant decline in VAP incidence density rates was observed, from 18.3 to 2.6 cases per 1000 ventilator days from the baseline to the final period.
CONCLUSIONS
Systematic implementation of VAP preventive measures significantly reduced VAP incidence. However, this reduction did not translate into decreased overall ICU mortality.
IMPLICATIONS FOR PRACTICE
The study underscores the importance of continuous VAP surveillance and preventive measures in reducing VAP incidence.
目的
通过逐步引入预防策略来描述呼吸机相关性肺炎（VAP）的预防与控制实践，并评估其对VAP发病率的影响。
设计
一项为期13年的历史性观察性监测研究。
地点
比利时一家综合医院的一个拥有12张床位的成人重症监护病房（ICU）。
参与者
2007年至2019年期间入住ICU且住院时间≥48小时的患者。
干预措施
从2008年开始逐步引入VAP预防措施，包括床头抬高、气囊压力控制、带锥形气囊的气管插管、声门下分泌物引流、洗必泰口腔护理以及每日镇静评估。
测量指标及主要结果
观察到VAP发病密度率显著下降，从基线期的每1000个呼吸机日18.3例降至最后阶段的每1000个呼吸机日2.6例。
结论
系统实施VAP预防措施可显著降低VAP发病率。然而，这种降低并未转化为ICU总体死亡率的下降。
对实践的启示
该研究强调了持续进行VAP监测和预防措施对降低VAP发病率的重要性。
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