Giang Bui Thi Huong, Matsubara Chieko, Okamoto Tatsuya, Hoan Hoang Minh, Yonehiro Yuki, Nguyen Duong Thi, Maehara Yasuhiro, Sekihara Keigo, Tuan Dang Quoc, Thanh Do Van, Co Dao Xuan
Department of Emergency and Critical Care Medicine, Hanoi Medical University, No.1, Ton That Tung Street, Trung Tu ward, Dong Da district, Hanoi 100000, Vietnam.
Department of Intensive Care Medicine, Bach Mai Hospital, 78 Giai Phong Road, Ha Noi 100000, Vietnam.
Healthcare (Basel). 2025 Feb 20;13(5):443. doi: 10.3390/healthcare13050443.
We developed a 10-item VAP care bundle to address the high incidence of VAP in Vietnamese intensive care units (ICUs), comprising (i) hand hygiene, (ii) head elevation (gatch up 30-45°), (iii) oral care, (iv) oversedation avoidance, (v) breathing circuit management, (vi) cuff pressure control, (vii) subglottic suctioning of secretions, (viii) daily assessment for weaning and a spontaneous breath trial (SBT), (ix) early ambulation and rehabilitation, and (x) prophylaxis of peptic ulcers and deep-vein thrombosis (DVT). The VAP incidence (27.0 per 1000 mechanical ventilation days) slightly and not significantly decreased in the six months after the implementation of the care bundle. However, the VAP incidence (11.3 per 1000 mechanical ventilation days) significantly decreased when we updated the two-item protocol with interactive communication and education ( < 0.001). Although the effectiveness of the interventions via protocol updates with interactive education needs further study, this intervention can make a VAP care bundle work in a resource-constrained and multidrug-resistant environment.
我们制定了一项包含10项内容的呼吸机相关性肺炎（VAP）护理集束措施，以应对越南重症监护病房（ICU）中VAP的高发病率，该护理集束措施包括：（i）手部卫生，（ii）床头抬高（摇高30 - 45°），（iii）口腔护理，（iv）避免过度镇静，（v）呼吸回路管理，（vi）气囊压力控制，（vii）声门下分泌物吸引，（viii）每日进行撤机评估和自主呼吸试验（SBT），（ix）早期活动和康复，以及（x）预防消化性溃疡和深静脉血栓形成（DVT）。在实施该护理集束措施后的六个月里，VAP发病率（每1000机械通气日27.0例）略有下降，但无显著差异。然而，当我们通过互动沟通和教育更新两项协议时，VAP发病率（每1000机械通气日11.3例）显著下降（<0.001）。尽管通过互动教育更新协议进行干预的效果还需要进一步研究，但这种干预措施能够使VAP护理集束措施在资源有限和多重耐药的环境中发挥作用。
