The Role of Maintaining Constant Pressure of the Endotracheal Catheter Cuff in Prevention of Ventilator-associated Pneumonia_West China Medical Journal

Authors：

 ZhuMinghua ¹ , QiuZhihong ² , LiuHua ¹ , NaYiwen ¹ , LiHong ² , LiuYingjie ³ , MiaoQin ¹ , HeJingzhi ¹ , DaiKunpeng ¹ ,  LiuHaitao ¹

1. Department of Nosocomial Infection Management;North China Petroleum Bureau General Hospital Affiliated to Hebei Medical University, Renqiu, Hebei 062552, P. R. China;
2. Department of Respiratory Medicine;North China Petroleum Bureau General Hospital Affiliated to Hebei Medical University, Renqiu, Hebei 062552, P. R. China;
3. Department of Medical Equipment;North China Petroleum Bureau General Hospital Affiliated to Hebei Medical University, Renqiu, Hebei 062552, P. R. China;

Corresponding author：

LiuHaitao, Email: 18632738079@126.com

Keywords：

Pressure gauges; Cluster management; Endotracheal catheter cuff pressure; Ventilator-associated pneumonia

DOI：

10.7507/1002-0179.201600115

Video：

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Objective To explore the preventive role of maintaining constant pressure of the endotracheal catheter cuff on ventilator-associated pneumonia (VAP). Methods From January to December 2015, 96 patients of type Ⅱ respiratory failure were selected as the trial group who underwent intubation and mechanical ventilation more than 48 hours in the Intensive Care Unit (ICU). We used pressure gauges to measure the endotracheal catheter cuff pressure regularly and maintained a constant pressure in addition to the application of artificial airway cluster management. We recorded the initial pressure value which was estimated by pinching with finger and set initial pressure to 30 cm H₂O (1 cm H₂O=0.098 kPa). We measured endotracheal catheter cuff pressure and recorded it during different intervals. We reviewed 88 patients with the same disease as the control group who only accepted artificial airway cluster management between January and December 2014. Mechanical ventilation time, VAP occurrence time, ICU admission time, the incidence of VAP were recorded and analyzed for both the two groups of patients. Results In the trial group, the initial pressure of endotracheal catheter cuff which was estimated by pinching with finger showed that only 11.46% of pressure was between 25 and 30 cm H₂O and 82.29% of the pressure was higher than 30 cm H₂O. We collected endotracheal catheter cuff pressure values during different interval time by using pressure gauges to maintain a constant management. The ratio at the pressure between 25 and 30 cm H₂O was respectively 41.32%, 43.75%, 64.20%, 76.54%, 91.13%, and 91.85%. ICU admission time, mechanical ventilation time in patients of the trial group decreased more, compared with the control group, and the differences were statistically significant (t=4.171, P<0.001; t=4.061, P<0.001). The VAP occurrence time in patients of the trial group was later than the control group (t=2.247, P<0.001). Conclusion The endotracheal catheter cuff pressure estimated by pinching with finger has errors. We recommend using pressure gauges to detect pressure every four hours, which utilizes minimal time to maintain effective pressure. The method of artificial airway of cluster management combined with the pattern of maintaining constant endotracheal catheter cuff pressure can shorten ICU admission time, mechanical ventilation time and delay the occurrence of VAP.

Citation： ZhuMinghua, QiuZhihong, LiuHua, NaYiwen, LiHong, LiuYingjie, MiaoQin, HeJingzhi, DaiKunpeng, LiuHaitao. The Role of Maintaining Constant Pressure of the Endotracheal Catheter Cuff in Prevention of Ventilator-associated Pneumonia. West China Medical Journal, 2016, 31(3): 422-426. doi: 10.7507/1002-0179.201600115 Copy

1.	孙彩霞. ICU呼吸机相关性肺炎的原因分析及护理对策[J]. 中华医院感染学杂志, 2013, 23(5):1007-1009.
2.	李军, 李素玲, 韩军. 气流冲击法清除气囊上滞留物对气管插管患者预防呼吸机相关性肺炎的效果评价[J]. 中国实用护理杂志, 2012, 28(36):45-46.
3.	杜志强, 施青山, 李凤诗. 气囊上滞留物引流对呼吸机相关性肺炎的影响及致病菌分析[J]. 检验医学与临床, 2014, 11(4):465-467.
4.	中华医学会重症医学分会. 机械通气临床应用指南(2006)[J]. 中国危重病急救医学, 2007, 19(2):65-72.
5.	Augustyn B. Ventilator-associated pneumonia:risk factors and prevention[J]. Crit Care Nurse, 2007, 27(4):32.
6.	刘竹, 黄琼华, 安寒, 等. 重症监护病房呼吸机相关肺炎的集束干预效果观察[J]. 华西医学, 2014, 29(3):449-451.
7.	李丽华, 王丽. 综合ICU呼吸机相关性肺炎的预防及护理措施[J]. 华西医学, 2010, 25(9):1745-1746.
8.	王峥, 张连心. 重症监护室发生呼吸机相关性肺炎的相关危险因素及对策分析[J]. 中外医学研究, 2015, 13(6):31-32.
9.	中华医学会呼吸病分会呼吸治疗学组. 人工气道气囊的管理专家共识[J]. 中华结核和呼吸杂志, 2014, 37(11):816-819.
10.	中华医学会重症医学分会. 呼吸机相关性肺炎预防、诊断及治疗指南(2013)[J]. 中华内科杂志, 2013, 52(6):1-20.
11.	张长春, 贾晓君, 王萍, 等. ICU呼吸机相关性肺炎病原菌构成及耐药性分析[J]. 中华医院感染学杂志, 2014, 24(1):47-49.
12.	Joseph NM, Sistla S, Dutta TK, et al. Ventilator-associated pneumonia:a review[J]. Eur J Intern Med, 2010, 21(5):360-368.
13.	Restrepo MI, Anzueto A, Arroliga AC, et al. Economic burden of ventilator-associated pneumonia based on total resource utilization[J]. Infect Control Hosp Epidemiol, 2010, 31(5):509-515.
14.	Rello J, Ollendorf DA, Oster G, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database[J]. Chest, 2002, 122(6):2115-2121.
15.	Sole ML, Penoyer DA, Su X, et al. Assessment of endotracheal cuff pressure by continuous monitoring:a pilot study[J]. Am J Crit Care, 2009, 18(2):133-143.
16.	李金芳, 邵芹, 王正梅, 等. 两种气囊压力检测方法预防呼吸机相关性肺炎的效果比较[J]. 中华现代护理杂志, 2012, 18(30):3697-3698.
17.	付优, 席修明. 机械通气患者低气囊压力的影响因素分析[J]. 中华危重病急救医学, 2014, 26(12):870-874.
18.	Rello J, Soñora R, Jubert P, et al. Pneumonia in intubated patients:role of respiratory airway care[J]. Am J Respir Crit Care Med, 1996, 154(1):111-115.

1. 孙彩霞. ICU呼吸机相关性肺炎的原因分析及护理对策[J]. 中华医院感染学杂志, 2013, 23(5):1007-1009.
2. 李军, 李素玲, 韩军. 气流冲击法清除气囊上滞留物对气管插管患者预防呼吸机相关性肺炎的效果评价[J]. 中国实用护理杂志, 2012, 28(36):45-46.
3. 杜志强, 施青山, 李凤诗. 气囊上滞留物引流对呼吸机相关性肺炎的影响及致病菌分析[J]. 检验医学与临床, 2014, 11(4):465-467.
4. 中华医学会重症医学分会. 机械通气临床应用指南(2006)[J]. 中国危重病急救医学, 2007, 19(2):65-72.
5. Augustyn B. Ventilator-associated pneumonia:risk factors and prevention[J]. Crit Care Nurse, 2007, 27(4):32.
6. 刘竹, 黄琼华, 安寒, 等. 重症监护病房呼吸机相关肺炎的集束干预效果观察[J]. 华西医学, 2014, 29(3):449-451.
7. 李丽华, 王丽. 综合ICU呼吸机相关性肺炎的预防及护理措施[J]. 华西医学, 2010, 25(9):1745-1746.
8. 王峥, 张连心. 重症监护室发生呼吸机相关性肺炎的相关危险因素及对策分析[J]. 中外医学研究, 2015, 13(6):31-32.
9. 中华医学会呼吸病分会呼吸治疗学组. 人工气道气囊的管理专家共识[J]. 中华结核和呼吸杂志, 2014, 37(11):816-819.
10. 中华医学会重症医学分会. 呼吸机相关性肺炎预防、诊断及治疗指南(2013)[J]. 中华内科杂志, 2013, 52(6):1-20.
11. 张长春, 贾晓君, 王萍, 等. ICU呼吸机相关性肺炎病原菌构成及耐药性分析[J]. 中华医院感染学杂志, 2014, 24(1):47-49.
12. Joseph NM, Sistla S, Dutta TK, et al. Ventilator-associated pneumonia:a review[J]. Eur J Intern Med, 2010, 21(5):360-368.
13. Restrepo MI, Anzueto A, Arroliga AC, et al. Economic burden of ventilator-associated pneumonia based on total resource utilization[J]. Infect Control Hosp Epidemiol, 2010, 31(5):509-515.
14. Rello J, Ollendorf DA, Oster G, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database[J]. Chest, 2002, 122(6):2115-2121.
15. Sole ML, Penoyer DA, Su X, et al. Assessment of endotracheal cuff pressure by continuous monitoring:a pilot study[J]. Am J Crit Care, 2009, 18(2):133-143.
16. 李金芳, 邵芹, 王正梅, 等. 两种气囊压力检测方法预防呼吸机相关性肺炎的效果比较[J]. 中华现代护理杂志, 2012, 18(30):3697-3698.
17. 付优, 席修明. 机械通气患者低气囊压力的影响因素分析[J]. 中华危重病急救医学, 2014, 26(12):870-874.
18. Rello J, Soñora R, Jubert P, et al. Pneumonia in intubated patients:role of respiratory airway care[J]. Am J Respir Crit Care Med, 1996, 154(1):111-115.

West China Medical Journal

The Role of Maintaining Constant Pressure of the Endotracheal Catheter Cuff in Prevention of Ventilator-associated Pneumonia

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