一种新型自动智能吸引装置(VapCare)在机械通气神经危重症患者中的安全性和有效性:一项前瞻性随机试验。

IF 3.6 3区 医学 Q2 CLINICAL NEUROLOGY
Neurocritical Care Pub Date : 2025-10-01 Epub Date: 2025-04-11 DOI:10.1007/s12028-025-02253-w
M S Varnitha, P Murlidhara, Archana Sharma, V Sudhir, Shwetha S Naik, Dhritiman Chakrabarti
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引用次数: 0

摘要

背景:呼吸机相关性肺炎(VAP)是重症监护病房(icu)的一个重要问题,影响7-32%的机械通气患者,其发病率和死亡率较高,住院时间延长。预防VAP涉及细致的分泌物管理和口腔卫生,但在资源匮乏的环境中,由于缺乏标准化的口腔护理方案,VAP仍然很常见。这项随机研究评估了VapCare自动分泌管理装置在减少通气患者微抱负和改善临床结果方面的有效性和安全性。方法:一项单中心、开放标签的随机试验,纳入需要机械通气48小时或更长时间的成年神经危重症患者,排除气管造口术患者和出血障碍、气道困难或既往存在的肺炎患者。参与者被随机分配到对照组,接受标准的ICU护理和手动口咽吸引,或研究组,接受VapCare管理。我们比较了第1天至第5天的肺部超声评分(LUS)、临床肺部感染评分(CPIS)、分泌物量、气管培养和胸部x线结果。结果:与对照组相比,VapCare组LUS和CPIS的上升速度较慢。对照组的CPIS中位数从第一天的1(四分位数范围[IQR] 1-2)上升到第5天的5 (IQR 2.75-6),而VapCare组的CPIS中位数从第1天的1 (IQR 0-2)上升到第5天的3 (IQR 2-3) (p)。结论:VapCare设备有效地减少了微吸,减轻了肺部变化,显示了其减轻通气患者微吸和吸引负担的可能性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Safety and Efficacy of a Novel Automated Intelligent Suction Device (VapCare) Among Mechanically Ventilated Neurocritical Care Patients: A Prospective Randomized Trial.

Background: Ventilator-associated pneumonia (VAP) is a significant concern in intensive care units (ICUs), affecting 7-32% of mechanically ventilated patients, which mounts to higher morbidity and mortality and extended hospital stays. Preventing VAP involves meticulous secretion management and oral hygiene, but in low-resource settings, VAP remains common owing to the absence of standardized oral care protocols. This randomized study assessed the efficacy and safety of the VapCare automated secretion management device in reducing microaspirations and improving clinical outcomes in ventilated patients.

Methods: A single-center, open-label randomized trial was conducted involving adult neurocritical care patients requiring mechanical ventilation for 48 h or more, excluding tracheostomized patients and patients with bleeding disorders, difficult airways, or preexisting pneumonia. Participants were randomly assigned to a control group, receiving standard ICU care with manual oropharyngeal suctioning, or a study group, receiving VapCare management. We compared lung ultrasound scores (LUS), clinical pulmonary infection scores (CPIS), secretion volumes, tracheal cultures, and chest X-ray results from day 1 to day 5.

Results: The VapCare group demonstrated a slower rise in LUS and CPIS compared to the control group. The median CPIS rose from 1 (interquartile range [IQR] 1-2) on the first day to 5 (IQR 2.75-6) on the fifth day in the control group versus 1 (IQR 0-2) on the first day to 3 (IQR 2-3) on the fifth day in the VapCare group (p < 0.001). The median LUS increased from 0 (IQR 0-2) on the first day to 6 (IQR 2-10) on the fifth in the control group, whereas the change was more muted in the VapCare group (0 [IQR 1-2] on the first day to 4 [IQR 2-6] on the fifth day [p < 0.001]). Additionally, chest X-ray scores were lower in the VapCare group (p = 0.028). Tracheal culture microbial growth and mortality were similar in both groups, but the length of ICU stay was significantly shorter in the VapCare group (p = 0.004). One patient in the VapCare group sustained mucosal erosions on the lip due to the VapCare mouthpiece.

Conclusions: The VapCare device effectively reduces microaspiration and mitigates lung changes, demonstrating its potential to reduce the burden of microaspiration and suctioning in ventilated patients.

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来源期刊
Neurocritical Care
Neurocritical Care 医学-临床神经学
CiteScore
7.40
自引率
8.60%
发文量
221
审稿时长
4-8 weeks
期刊介绍: Neurocritical Care is a peer reviewed scientific publication whose major goal is to disseminate new knowledge on all aspects of acute neurological care. It is directed towards neurosurgeons, neuro-intensivists, neurologists, anesthesiologists, emergency physicians, and critical care nurses treating patients with urgent neurologic disorders. These are conditions that may potentially evolve rapidly and could need immediate medical or surgical intervention. Neurocritical Care provides a comprehensive overview of current developments in intensive care neurology, neurosurgery and neuroanesthesia and includes information about new therapeutic avenues and technological innovations. Neurocritical Care is the official journal of the Neurocritical Care Society.
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