重型颅脑损伤延长机械通气早期气管切开术预防呼吸机相关性肺炎(VAP)

P. Ananda, Sony
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引用次数: 0

摘要

导读:如果预期长期使用呼吸机,需要考虑早期气管切开术。建议早期气管切开术,因为它可以改善呼吸功能,降低呼吸机相关性肺炎的风险,改善患者舒适度,清洁喉咙分泌物,减少喉部溃疡,改善活动和言语能力,并允许在重症监护病房(ICU)外进行治疗。病例报告:我们报告4例重型颅脑损伤合并早期气管切开术的病例,以说明VAP的预防。在这4例病例中,考虑到初始临界GCS,病变位置,预计长期使用机械通气,早期气管切开(£4天)。在治疗期间,痰培养检查证实无VAP。根据一项荟萃分析研究,与延迟/晚期气管切开术(> 10天)或延长插管(> 14天)相比,早期气管切开术可降低VAP死亡率高达50%,并缩短ICU住院时间。结论:应用VAP Bundle进行VAP预防工作。早期气管切开术比延长插管或延迟/晚期气管切开术提供更多的好处。VAP Bundle对每一位使用呼吸机的患者都进行了VAP Bundle治疗,科学证明VAP Bundle的应用可以将VAP的发生率降低25%。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Early Tracheostomy in Prolonged Mechanical Ventilation Due to Severe Head Injury to Prevent Ventilator-Associated Pneumonia (VAP)
Introduction: Early tracheostomy needs to be considered if the use of a ventilator is expected to be used for a long time. Early Tracheostomy is recommended because it can improve respiratory function, reduce the risk of Ventilator-Associated Pneumonia, improve patient comfort, cleanse secretions in the throat, reduce laryngeal ulceration, improve mobilization, and speech efforts, and allow treatment outside the Intensive Care Unit (ICU). Case Report: We report four cases of severe head injury with early tracheostomy which illustrates prevent of VAP. In these four cases, early tracheostomy was performed (£ 4 days) with consideration of the initial critical GCS, the location of the lesion, and mechanical ventilation is expected to be used for a long period time. During treatment, there is no VAP which is evidenced by a sputum culture examination. Based on a meta-analysis study early tracheostomy can reduce mortality due to VAP by up to 50% and reduce the length of stay in ICU compared to delayed/late tracheostomy (> 10 days) or prolonged intubation (> 14 days). Conclusion: VAP prevention efforts are carried out by applying VAP Bundle. An early tracheostomy provides more benefits than prolonged intubation or delayed/late tracheostomy. VAP Bundle is performed on every patient who uses a ventilator, and it can be proven scientifically that the application of VAP Bundle can reduce the incidence of VAP by up to 25%.
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