Ventilator-associated pneumonia and suction: a review of the literature

The Effect of Hypertonic Saline Nebulization on Arterial Blood Gas Parameters Among Patients on a Mechanical Ventilator

Introduction Care of the airway is an essential part of the management of patients receiving mechanical ventilation. If the airway is not properly managed, an endotracheal airway can result in retained secretions, airway obstructions, and infections. These complications may prolong mechanical ventilation duration and length of hospital stay and may increase the cost of affordability. Hypertonic saline nebulized suctioning is a technique used to lessen the duration of mechanical air flow and enhance airway clearance, which helps patients on mechanical ventilation breathe easier. Aim The objective of the study is to assess the effectiveness of nebulization with hypertonic saline on arterial blood gas parameters among mechanically ventilated patients. Methods The quasi-experimental design adopted with thirty-five mechanically ventilated samples was chosen using a non-probability purposive sample technique. Following the pre-test in the endotracheal tube, nebulization was given with 2 ml of hypertonic saline over 15-20 mins, two times each day, to the mechanically ventilated patients. Post-test was carried out about 15-20 minutes after the procedure using arterial blood gas analysis results were obtained and interpreted. Results The study reveals that the p values corresponding to the arterial blood gas parameters PCo2, pO2, and HCo3 are less than 0.01 and are significant at a 1% level, and arterial blood gas (ABG) pH is less than 0.05 and is significant at a 5% level; hence there is a high significant difference between the pre-test and post-test mean scores of arterial blood gas parameters PCo2, pO2, HCo3, and ABG pH. Hence, the study concluded that nebulization with hypertonic saline for patients with mechanical ventilators is more effective in improving arterial blood gas parameters.

Role of bronchoscopy in the management of patients with suspected or suffering from ventilator-associated pneumonia: A meta-analysis

Background

The utility of bronchoscopy in the treatment of patients with ventilator-associated pneumonia (VAP) has been proposed, although prior research has yielded inconclusive findings. This systematic review and meta-analysis were conducted to examine the impact of bronchoscopy on mortality rates, duration of mechanical ventilation (MV), and length of stay in the intensive care unit (ICU) among patients with VAP.

Methods

Relevant randomized controlled trials (RCTs) and cohort studies were acquired by conducting a comprehensive search in the PubMed, Embase, and Cochrane Library databases. To account for the potential heterogeneity, a random-effects model was utilized to combine the findings and incorporate its potential influence.

Results

Eight RCTs and three cohort studies, including 3907 patients with highly suspected or clinically diagnosed VAP, were included. Compared to the controls, bronchoscopy use was not associated with a significant effect on all-cause mortality (relative risk [RR]: 0.81, 95 % confidence interval [CI]: 0.62 to 1.05, p = 0.12; I2 = 57 %). Subgroup analysis showed that bronchoscopy used for the microbiological diagnosis of VAP was not associated with reduced mortality (RR: 0.92, 95 % CI: 0.75 to 1.13), while therapeutic bronchoscopy use was associated with significantly reduced mortality (RR: 0.53, 95 % CI: 0.35 to 0.81). The duration of MV or length of ICU stay was not significantly different between groups.

Conclusions

Bronchoscopy use for the purpose of the microbiological diagnosis of VAP did not reduce short-term mortality compared to diagnosis without bronchoscopy use, while therapeutic bronchoscopy use was associated with reduced mortality in these patients.

Effect of open versus closed endotracheal suctioning on intracranial pressure in severe brain-injured children: Study protocol for a randomized controlled trial

AIM

To compare the effects and safety of open and closed endotracheal suction in children with severe brain injury.

DESIGN

A single-blinding, single-centre randomized controlled trial (RCT).

METHODS

The children with severe brain injury admitted to the intensive care unit (ICU) from 1 September 2020-31 August 2022 will be included. And a total of 172 children with severe brain injury are expected to be included. The intracranial pressure, SpO₂ and heart rate before suctioning, at the end of suction, and at 5 and 10 min after suction, the estimated sputum volume for each suction, the incidence of ventilator-associated pneumonia, the duration of mechanical ventilation and the length of ICU stay will be analysed.

RESULTS

This present RCT has been prospectively registered in China Clinical Trial Registry (http://www.chictr.org.cn, ChiCTR2000030963). This present study is expected to provide reliable evidence to the airway management in children with severe brain injury.

Effective Catheter Manoeuvre for the Removal of Phlegm by Suctioning: A Biomechanical Analysis of Experts and Novices

Purpose

The aim of this study was to determine the effective biomechanical technique for suctioning phlegm.

Methods

A novel tracheal suctioning simulator combined with a motion capture system was used to calculate the amount of simulated phlegm suctioned and the biomechanical parameters of the associated suctioning manoeuvre. A laboratory study, including 12 nurses with > 3 years of suctioning experience and 12 nursing students without any clinical suctioning experience, was conducted. The amount of phlegm suctioned, the maximum length of catheter insertion, and the biomechanical parameters of hand movement were calculated.

Results

The mean amount of phlegm suctioned per second was significantly larger in the experienced group than in the non-experienced group. The amount of phlegm suctioned correlated positively with the length of the vertical path of motion of the wrist and forearm, and with the angular velocity of thumb rotation in both the groups.

Conclusion

Greater vertical motion of the wrist and thumb rotation improved the effectiveness of phlegm suctioning and prevented the need for deep suctioning, which is unsafe.