Dissertation > Excellent graduate degree dissertation topics show

A Multicenter Epidemical Survey of VAP in 33 ICUs of Academic Hospital in China

Author: SongHaiJing
Tutor: MaPengLin
School: Third Military Medical University
Course: Critical Care Medicine
Keywords: Ventilator-associated pneumonia Epidemiological studies
CLC: R181.3
Type: Master's thesis
Year: 2010
Downloads: 191
Quote: 1
Read: Download Dissertation

Abstract

Background 1950s, mechanical ventilation (mechanical ventilation, MV) has wide application in clinical, become one of the main treatment in the ICU is an important means of life support rescue critically ill patients with respiratory failure. Achieved significant treatment outcomes, mechanical ventilation has also brought a number of serious complications, such as ventilator-associated pneumonia (ventilator associated pneumonia, VAP). Ventilator-associated pneumonia (VAP) the the ICU main hospital-acquired pneumonia (Hospital Acquired Pneumonia, HAP), accounting for about 85% of all ICU HAP [1]. Existing clinical studies confirm the occurrence of VAP will result in the duration of mechanical ventilation and ICU prolonged hospital stay, and increased health care costs, and affect the prognosis [6-9]. Therefore, effective prevention of VAP occurred has important clinical significance. 2. daily evacuation the sedatives wake patient (Daily wake-up) and to assess the ventilator to evacuate the possibility (SBT); prevention of gastrointestinal ulcers; 4. prevention of deep vein thrombosis. Ventilator Bundle overall implementation effectively reduce the incidence of VAP, confirmed the Ventilator Bundle is effective in preventing clinical measures to prevent VAP occurred. However, subsequent research results there are large differences [11-14]. Among them, one of the important issues is the the Ventilator Bundle clinical compliance is poor, affecting its clinical effectiveness. A single center of the People's Liberation Army 309 Hospital before and after the implementation of mechanical ventilation Bundle controlled studies have shown that poor the Ventilator Bundle clinical compliance, before and after the implementation of the Ventilator Bundle incidence of VAP found no significant effect [15]. Thus, through education and training to strengthen the the breathing machine the Bundle concept of the promotion, at the same time real-time inspection and supervision of the clinical implementation of the Ventilator Bundle is of great significance to improve the the Ventilator Bundle clinical compliance effectively reduce the incidence of VAP. The Ventilator Bundle Objective To understand the overall situation of the domestic ICU VAP occurred, prevention the VAP basic implementation of the measures and clinical effect, can be worked out a suitable for China's national conditions, clinical compliance and effective programs and to promote the implementation of providing practice based on exploring a reasonable method of execution, to contribute to reducing domestic incidence of VAP. The study in the June 11, 2009 to 2009 in the country's 33 three first-class hospital ICU continuous selection intubation and mechanical ventilation in patients with a total of 314 cases. Research centers mechanical ventilation treatment without any intervention, and follow the empirical treatment centers. Before the start of the experiment different regions batches designated project leader of the research center for research purposes, the observed indicators, CRF form requirements of centralized training, research centers designated project leader is responsible for follow-up training where the center of the project participants, research the guidance of the issues related to the whole process of the person responsible for the research center. Clinical data collected CRF tabular form. Each study center daily fill research diary, and faithfully record the total number of cases of mechanical ventilation in the day of the study center, the number of selected cases, the number of cases is not selected and not selected reasons. Clinical data with Epidata software blinded double-entry method of entry, inspection, confirmed that the experimental data and correct data export, using SAS statistical software for statistical analysis. The results of this study, a total of 314 cases enrolled patients. Average age of 60.85 ± 15.97 years old, the minimum age is 18 years old, the maximum age of 80 years old; men enrolled patients, 209 cases (66.56%); the mechanical ventilation reason for medical disorders in 184 cases (58.60%), surgical diseases, 130 cases (41.40% ); average APACHE Ⅱ score was 19.19 ± 6.63; selected cases, the average head elevation angle of 23.46 ± 6.99 degrees; incidence of VAP number of cases to 125 cases, VAP was 39.81%; total mechanical ventilation Day is for 2482 days , 50.36 / thousand mechanical ventilation Day the per thousand mechanical ventilation Day the number of cases of VAP; deaths of 28-day follow-up results of 105 cases, 28-day mortality was 33.44%; deaths in the ICU for 59 cases, accounting for the proportion of 28-day deaths 56.19 %; 27 patients with VAP-related deaths accounted for 28 deaths ratio was 25.71%. VAP group developed VAP group did not occur each indicator analysis the average APACHE Ⅱ score, ICU length of hospital stay, duration of mechanical ventilation, the average head elevation, significant differences between the five variables of mortality in the ICU. Will be selected depending on the duration of mechanical ventilation were divided into mechanical ventilation time ≤ 3 days, 4-7 days, gt; 7 days 3 groups, the incidence of VAP between groups were 18.03%, 42.53%, 57.30%, and the difference was statistically significant , prompted extended with the duration of mechanical ventilation, increased the incidence of VAP. Implementation of the to prevent VAP basic measures of clinical grouping, where the incidence of VAP, head elevation angle completely group of more than 30 ° below Bedside high angle completely group below 30 ° head elevation completed and not with the prolongation of the duration of mechanical ventilation was significantly decreased. Time of admission to the ICU has divided into two groups, to July 10 Packet point in time, the selected cases. Between the two groups of data comparison and statistical analysis of the significant differences between the two variable group average head elevation angle and the incidence of VAP. Conclusion (1) In this study, by using the multi-center epidemiological studies of 33 top three hospitals in the ICU VAP epidemiological studies, to some extent reflects the current domestic large hospital ICU within VAP occurrence. Studies have shown that participate in research centers overall incidence of VAP (39.81%) is slightly higher than the level of developed countries. Effective intervention needs to take measures to prevent the occurrence of VAP. (2) VAP incidence of patients with ICU length of hospital stay and mechanical ventilation time may be extended, at the same time in ICU mortality. (3) into ICU patients receiving mechanical ventilation, the worse the overall situation, the greater the likelihood of its occurrence of VAP; receiving mechanical ventilation, the longer the duration of treatment, the higher the incidence of VAP. (4) ≥ 30 ° head elevation is effective in preventing VAP occurred one of the factors. (5) The head elevation angle ≥ 30 ° has not been widely implemented, the clinical implementation rate is very low. By strengthening the education and training of medical staff, clinical compliance can be improved.

Related Dissertations

CLC: > Medicine, health > Preventive Medicine,Health > Epidemiology and Prevention of Disease > Epidemiology of the basic theory and methods > Special epidemiological each
© 2012 www.DissertationTopic.Net Mobile