- 期刊
預防呼吸器相關性肺炎組合式照護
Ventilator-associated Pneumonia Prevention Bundle Care
摘要
預防感染為重症患者重要課題。呼吸器相關性肺炎，泌尿道感染與導管相關血流感染為重症患者三大感染原因。呼吸器相關性肺炎是造成重症患者死亡的主因之一，它會延長呼吸器使用時間、加護病房使用天數，死亡率可高達30～50%，預防呼吸器相關性肺炎的產生乃當務之急，它不但能減少醫療花費，也能降低死亡率。預防呼吸器相關性肺炎的措施包含勤洗手；提高護理人力對病人比例；預防呼吸道嗆入（頭部抬高30至45度、抽吸聲門下分泌物、維持氣管內管氣囊壓力在20至35 cmH_2O）；減少口腔或消化道的細菌（使用chlorhexidine去除口腔細菌、於消化道使用抗生素）；另外，每日中斷鎮定劑使用、早期拔除氣管內管、早日脫離呼吸器都是減少呼吸器相關性肺炎的措施。使用組合式照護，綜合多種有效的方式一起預防感染，會有效降低呼吸器相關性肺炎產生的機會。沒有研究顯示哪一種組合式照護是預防呼吸器相關性肺炎最好的組合式治療，然而，早期拔管是最有效降低呼吸器相關性肺炎的方法。醫療院所依據個別狀況選擇3至5項實証做為組合式照護項目時，應優先考慮納入使用脫離呼吸器流程，降低呼吸器使用天數，做為建立預防呼吸器相關性肺炎的組合式照護的首要策略。
並列摘要
Prevention of infection is important issue for critical care. Ventilator-associated pneumonia (VAP), urinary tract and bloodstream infection are the three most common infection in the critically ill patients. VAP is one of the most common causes of mortality, and it increases duration of mechanical ventilation, stay of intensive care unit (ICU) and mortality rate up to 30-50%. Prevention of VAP is critical issue, it can reduce medical cost and mortality rate. The strategies of VAP prevention include hand hygiene, nurse staffing, prevention of aspiration (elevation of the head of the bed, drainage of subglottic secretions, endotracheal cuff pressure maintaining 20 to 35 cmH_2O), selective oral or digestive decontamination, daily interruption of sedation, early weaning from ventilator and removal of endotracheal tube. To perform bundling multiple interventions has an additive benefit, but there is no consensus on the ideal set of interventions to be included in VAP prevention bundles. Ventilator weaning protocols have striking success in decreasing length of patients' ventilator usage and ICU days, resulting in decreasing incidence of VAP. This strategy is the most important when considering a VAP prevention bundle care.