Vallés J, Artigas A, Rello J, Bonsoms N, Fontanals D, Blanch L, Fernández R, Baigorri F, Mestre J
Intensive Care Department, Hospital de Sabadell, Barcelona, Spain.
Ann Intern Med. 1995 Feb 1;122(3):179-86. doi: 10.7326/0003-4819-122-3-199502010-00004.
To determine whether continuous subglottic aspiration prevents nosocomial pneumonia in mechanically ventilated patients.
A randomized, controlled, blinded study.
Medical-surgical intensive care unit.
190 patients who were admitted to the intensive care unit during a 33-month period and whose condition suggested the need for prolonged intubation (> 3 days).
76 patients were randomly allocated to receive continuous aspiration of subglottic secretions, and 77 control patients were allocated to receive usual care.
The numbers of cases of ventilator-associated pneumonia, ventilated days, days in intensive care unit, and deaths were recorded. The amount of subglottic secretions aspirated daily and surveillance cultures in the subglottic secretions were also obtained periodically. Etiologic diagnosis was based on the quantitative culture of secretions obtained by protected specimen brush or bronchoalveolar lavage.
The incidence rate of ventilator-associated pneumonia was 19.9 episodes/1000 ventilator days in the patients receiving continuous aspiration of subglottic secretions and 39.6 episodes/1000 ventilator days in the control patients (relative risk, 1.98; 95% CI, 1.03 to 3.82). This difference was due to a significant (P < 0.03) reduction in the number of gram-positive cocci and Haemophilus influenzae organisms in the patients receiving continuous aspiration. However, no differences were observed in the number of Pseudomonas aeruginosa or Enterobacteriaceae organisms. Episodes of ventilator-associated pneumonia occurred later in patients receiving continuous aspiration (12.0 +/- 7.1 days) than in the control patients (5.9 +/- 2.1 days) (P = 0.003). The same microorganisms isolated from protected specimen brush or bronchoalveolar lavage cultures in patients with ventilator-associated pneumonia were previously isolated from cultures of subglottic secretions in 85% of cases. No significant differences in outcome were found.
The incidence of nosocomial pneumonia in mechanically ventilated patients can be significantly reduced by using a simple method that decreases the chronic microaspirations through the cuff of endotracheal tubes.
确定持续声门下吸引能否预防机械通气患者发生医院获得性肺炎。
一项随机、对照、盲法研究。
内科-外科重症监护病房。
在33个月期间入住重症监护病房且病情提示需要长期插管（>3天）的190例患者。
76例患者被随机分配接受声门下分泌物持续吸引，77例对照患者接受常规护理。
记录呼吸机相关性肺炎病例数、机械通气天数、重症监护病房住院天数及死亡人数。还定期获取每日声门下吸出分泌物量和声门下分泌物的监测培养结果。病因诊断基于通过保护性标本刷检或支气管肺泡灌洗获取的分泌物定量培养。
接受声门下分泌物持续吸引的患者中呼吸机相关性肺炎发病率为19.9例/1000机械通气日，对照患者为39.6例/1000机械通气日（相对危险度，1.98；95%可信区间，1.03至3.82）。这种差异是由于接受持续吸引的患者中革兰氏阳性球菌和流感嗜血杆菌数量显著减少（P<0.03）。然而，铜绿假单胞菌或肠杆菌科细菌数量未观察到差异。接受持续吸引的患者发生呼吸机相关性肺炎的时间较晚（12.0±7.1天），而对照患者为（5.9±2.1天）（P = 0.003）。呼吸机相关性肺炎患者通过保护性标本刷检或支气管肺泡灌洗培养分离出的相同微生物，85%的病例先前已从声门下分泌物培养中分离出。结局未发现显著差异。
通过一种简单方法减少经气管插管套囊的慢性微量误吸，可显著降低机械通气患者医院获得性肺炎的发病率。
