Hagler D A, Traver G A
University of Arizona, College of Nursing, Tucson 85721.
Am J Crit Care. 1994 Nov;3(6):444-7.
Normal saline instillation prior to endotracheal suctioning is a critical care ritual that persists despite a lack of demonstrated benefit. Saline instillation may dislodge viable bacteria from a colonized endotracheal tube into the lower airway, overwhelming the defense mechanism of immunocompromised patients.
To determine the extent to which normal saline irrigation and suction catheter insertion dislodge viable bacteria from endotracheal tubes.
Endotracheal tubes from 10 critical care patients intubated for at least 48 hours were obtained immediately after extubation. Each tube was used in random order for both saline instillation and suction catheter insertion. Dislodged material was cultured for quantitative analysis.
Suction catheter insertion dislodged up to 60,000 viable bacterial colonies. A 5-mL saline instillation dislodged up to 310,000 viable bacterial colonies.
The potential for infection caused by dislodging bacteria into the lower airway is additional evidence that routine use of saline during suctioning procedures should be abandoned.
气管内吸痰前滴注生理盐水是重症监护中的一项常规操作，尽管尚无证据表明其有益，但仍持续存在。滴注生理盐水可能会将定植于气管内导管的活菌冲入下呼吸道，使免疫功能低下患者的防御机制不堪重负。
确定生理盐水冲洗和插入吸痰导管将气管内导管中的活菌冲出的程度。
10例接受气管插管至少48小时的重症监护患者在拔管后立即获取气管内导管。每根导管随机用于滴注生理盐水和插入吸痰导管。对冲出的物质进行培养以进行定量分析。
插入吸痰导管可冲出多达60,000个活菌菌落。滴注5毫升生理盐水可冲出多达310,000个活菌菌落。
将细菌冲入下呼吸道导致感染的可能性是进一步的证据，表明应摒弃在吸痰过程中常规使用生理盐水的做法。
