以质量求发展，以服务铸品牌

护理学报 ›› 2023, Vol. 30 ›› Issue (18): 36-41.doi: 10.16460/j.issn1008-9969.2023.18.036

• 循证护理 • 上一篇    下一篇

机械通气患者隐性误吸识别与预防的最佳证据总结

侯亚甜1, 陈思诺1, 刘孟慧1, 张博文1, 安祥1, 刘允2a, 徐文琪1, 章明阳2b   

  1. 1.河南大学 护理与健康学院,河南 开封 475000;
    2.中山市人民医院 a.护理部;b.手术麻醉三科,广东 中山 528400
  • 收稿日期:2023-08-03 出版日期:2023-09-25 发布日期:2023-10-11
  • 通讯作者: 章明阳（1987-）,男,河南信阳人,硕士,博士研究生在读,副主任护师。E-mail：jdzmy2010@163.com
  • 作者简介:侯亚甜（1998-）,女,河南洛阳人,本科学历,硕士研究生在读。
  • 基金资助:
    2021年度中山市第三批社会公益与基础研究项目（医疗卫生重大、重点项目）（2021B3014）

Best evidence summary for identification and prevention of silent aspiration in mechanically ventilated patients

HOU Ya-tian1, CHEN Si-nuo1, LIU Meng-hui1, ZHANG Bo-wen1, AN Xiang1, LIU Yun2a, XU Wen-qi1, ZHANG Ming-yang2b   

  1. 1. School of Nursing and Health, Henan University, Kaifeng 475000, China;
    2a. Dept. of Nursing Administration; 2b. Dept. of Surgery Anesthesia III, Zhongshan People's Hospital, Zhongshan 528400, China
  • Received:2023-08-03 Online:2023-09-25 Published:2023-10-11

PDF (PC)

89

赞

摘要： 目的 总结机械通气患者隐性误吸识别与预防的最佳证据。方法 检索BMJ Best Practice、JBI循证卫生保健中心数据库、国际指南图书馆（Guidelines International Network,GIN）、美国指南网（National Guideline Clearinghouse,NGC）、英国国家临床医学研究所指南库（National Institute for Health and Care Excellence,NICE）等关于机械通气患者隐性误吸识别与预防的文献,时限为建库至2023年2月。由2名研究者独立评价文献质量并提取证据。结果 共纳入文献25篇,围绕隐性误吸的识别、危险因素、气道管理、体位管理、喂养途径、临床监测、护士培训7个方面,汇总出23条最佳证据。结论 医护人员可参考本研究总结的证据,结合临床实际与患者意愿,识别和预防机械通气患者隐性误吸。

关键词: 机械通气, 隐性误吸, 预防, 循证护理学

Abstract: Objective To summarize the best evidence for the identification and prevention of silent aspiration in mechanically ventilated patients. Methods We searched databases including BMJ Best Practice, JBI, GIN, NGC, NICE to collect literature on the identification and prevention of silent aspiration in patients with mechanical ventilation, and the retrieval period was from the inception of the databases to February 2023. Two researchers independently evaluated literature quality and extracted the evidence. Results Twenty-five articles were selected,and 23 pieces of evidence were summarized from 7 aspects including identification of silent aspiration, risk factors, airway management, postural management, feeding routes, clinical monitoring, and nurse training. Conclusion Medical staff can refer to the evidence summarized in this study, to identify and prevent silent aspiration in patients with mechanical ventilation with the combination of clinical practice and patients' wishes.

Key words: mechanical ventilation, silent aspiration, prevention, evidence-based nursing

中图分类号: 

  • R473.56
[1] 中国吞咽障碍康复评估与治疗专家共识组. 中国吞咽障碍评估与治疗专家共识(2017年版)[J]. 中华物理医学与康复杂志, 2017, 39(12):881-892. DOI:10.3760/cma.j.issn.0254-1424.2017.12.001.
[2] Nseir S, Zerimech F, Jaillette E, et al.Microaspiration in intubated critically ill patients: diagnosis and prevention[J]. Infect Disord Drug Targets, 2011, 11(4):413-423. DOI:10.2174/187152611796504827.
[3] Metheny NA, Clouse RE, Chang YH, et al.Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients: frequency, outcomes, and risk factors[J]. Crit Care Med,2006, 34(4):1007-1015.DOI:10.1097/01.Ccm.0000206106.65220.59.
[4] Rouzé A, Jaillette E,Nseir S.Relationship between microaspiration of gastric contents and ventilator-associated pneumonia[J]. Ann Transl Med, 2018, 6(21):428. DOI:10.21037/atm.2018.07.36.
[5] Deem S, Yanez D, Sissons-Ross L, et al.Randomized pilot trial of two modified endotracheal tubes to prevent ventilator-associated pneumonia[J]. Ann Am Thorac Soc, 2016, 13(1):72-80. DOI:10.1513/AnnalsATS.201506-346OC.
[6] 中华医学会呼吸病学分会感染学组. 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版)[J]. 中华结核和呼吸杂志, 2018, 41(4):255-280. DOI:10.3760/cma.j.issn.1001-0939.2018.04.006.
[7] Sole ML, Talbert S, Yan X, et al.Impact of deep oropharyngeal suctioning on microaspiration, ventilator events, and clinical outcomes: a randomized clinical trial[J]. J Adv Nurs, 2019, 75(11):3045-3057. DOI:10.1111/jan.14142.
[8] Jaillette E, Girault C, Brunin G, et al.Impact of tapered-cuff tracheal tube on microaspiration of gastric contents in intubated critically ill patients: a multicenter cluster-randomized cross-over controlled trial[J]. Intensive Care Med, 2017, 43(11):1562-1571. DOI:10.1007/s00134-017-4736-x.
[9] Brouwers MC, Kho ME, Browman GP, et al.AGREE II: advancing guideline development, reporting, and evaluation in health care[J]. Prev Med, 2010, 51(5):421-424. DOI:10.1016/j.ypmed.2010.08.005.
[10] The JBI. JBI's critical appraisal tools assist in assessing the trustworthiness, relevance and results of published papers.[EB/OL]. (2017-11-24)[2023-08-31]. https://jbi.global/critical-appraisal-tools.
[11] 王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967. DOI:10.16821/j.cnki.hsjx.2015.11.002.
[12] NICE. PneuX to prevent ventilator-associated pneumonia [EB/OL]. (2020-04-08) [2023-08-31]. https://www.nice.org.uk/guidance/mtg48.
[13] NICE. Shiley Endotracheal Tube with TaperGuard Cuff for intensive care patients at risk of ventilator-associated pneumonia [EB/OL]. (2015-03-02) [2023-08-31]. https://www.nice.org.uk/advice/mib22.
[14] 中华医学会呼吸病学分会呼吸治疗学组. 人工气道气囊的管理专家共识(草案)[J]. 中华结核和呼吸杂志, 2014, 37(11):816-819. DOI:10.3760/cma.j.issn.1001-0939.2014.11.006.
[15] Blot SI, Rello J, Koulenti D.The value of polyurethane-cuffed endotracheal tubes to reduce microaspiration and intubation-related pneumonia: a systematic review of laboratory and clinical studies[J]. Crit Care, 2016, 20(1):203. DOI:10.1186/s13054-016-1380-8.
[16] 李豪, 徐榆林, 王海播, 等. 聚氨酯与聚氯乙烯气囊在有创通气患者中应用效果的Meta分析[J]. 护理实践与研究, 2022, 19(6):856-861. DOI:10.3969/j.issn.1672-9676.2022.06.016.
[17] 米元元, 沈月, 王宗华, 等. 机械通气患者误吸预防及管理的最佳证据总结[J]. 中华护理杂志, 2018, 53(7):849-856. DOI:10.3761/j.issn.0254-1769.2018.07.017.
[18] Talbert S, Bourgault AM, Rathbun KP, et al.Pepsin A in tracheal secretions from patients receiving mechanical ventilation[J]. Am J Crit Care, 2021, 30(6):443-450. DOI:10.4037/ajcc2021528.
[19] Nseir S, Gouge AL, Lascarrou JB, et al.Impact of nutrition route on microaspiration in critically ill patients with shock: a planned ancillary study of the NUTRIREA-2 trial[J]. Crit Care, 2019,23(1):111.DOI:10.1186/s13054-019-2403-z.
[20] Sole ML, Talbert S, Yan X, et al.Nursing oral suction intervention to reduce aspiration and ventilator events (NO-ASPIRATE): a randomized clinical trial[J]. J Adv Nurs, 2019, 75(5):1108-1118.DOI:10.1111/jan.13920.
[21] Jansson MM, Syrjälä HP, Ohtonen PP, et al.Effects of simulation education on oral care practices-a randomized controlled trial[J]. Nurs Crit Care, 2017, 22(3):161-168. DOI: 10.1111/nicc.12276.
[22] Nseir S, Zerimech F, Fournier C, et al.Continuous control of tracheal cuff pressure and microaspiration of gastric contents in critically ill patients[J]. Am J Respir Crit Care Med, 2011, 184(9):1041-1047. DOI:10.1164/rccm.201104-0630OC.
[23] Lucangelo U, Zin WA, Antonaglia V, et al.Effect of positive expiratory pressure and type of tracheal cuff on the incidence of aspiration in mechanically ventilated patients in an intensive care unit[J]. Crit Care Med, 2008, 36(2): 409-413. DOI:10.1097/01.Ccm.0000297888.82492.31.
[24] Young PJ, Pakeerathan S, Blunt MC, et al.A low-volume, low-pressure tracheal tube cuff reduces pulmonary aspiration[J]. Crit Care Med, 2006, 34(3):632-639. DOI:10.1097/01.Ccm.0000201406.57821.5b.
[25] Heyland DK, Drover JW, Macdonald S, et al.Effect of postpyloric feeding on gastroesophageal regurgitation and pulmonary microaspiration: results of a randomized controlled trial[J]. Crit Care Med, 2001, 29(8):1495-1501. DOI:10.1097/00003246-200108000-00001.
[26] Blunt MC, Young PJ, Patil A, et al.Gel lubrication of the tracheal tube cuff reduces pulmonary aspiration[J]. Anesthesiology, 2001, 95(2):377-381. DOI:10.1097/00000542-200108000-00019.
[27] 程安琪, 李雅楠, 夏欣华, 等. 两种气管导管预防机械通气患者呼吸机相关性肺炎效果比较[J].护理学杂志, 2017, 32(13):24-27. DOI:10.3870/j.issn.1001-4152.2017.13.024.
[28] 叶向红, 彭南海, 倪元红, 等. 腹腔高压行机械通气患者肠内营养期间微误吸的预防[J]. 解放军护理杂志, 2011, 28(5):21-24. DOI:10.3969/j.issn.1008-9993.2011.05.006.
[29] Spapen H, Suys E, Regt JD, et al.An endotracheal tube providing "pressurized sealing" prevents fluid leakage in mechanically ventilated critically ill patients: a pilot study[J]. J Anesth, 2020, 34(1):144-148. DOI:10.1007/s00540-019-02707-4.
[30] 张滢滢, 王海芳, 王玉宇, 等. ICU不同进食方式的患者误吸发生现状及特征比较[J]. 中华护理杂志, 2022, 57(3):265-271. DOI:10.3761/j.issn.0254-1769.2022.03.002.
[31] Ciampoli N, Bouchoucha S, Currey J, et al.Evaluation of prevention of ventilator-associated infections in four Australian intensive care units[J]. J Infect Prev, 2020, 21(4): 147-154. DOI:10.1177/1757177420908006.
[32] Belafsky PC, Blumenfeld L, Lepage A, et al.The accuracy of the modified Evan's blue dye test in predicting aspiration[J]. Laryngoscope, 2003, 113(11):1969-1972.DOI:10.1097/00005537-200311000-00021.
[33] Dewavrin F, Zerimech F, Boyer A, et al.Accuracy of alpha amylase in diagnosing microaspiration in intubated critically-ill patients[J]. PLoS One, 2014, 9(3):e90851. DOI:10.1371/journal.pone.0090851.
[34] 钟慈芳, 刘志琴, 区燕云, 等. 广东省6家医院呼吸科护士误吸知识水平现状的调查[J]. 护理学报, 2015, 22(13): 32-34. DOI:10.16460/j.issn1008-9969.2015.13.032.
[35] 黄赣英, 张晓庆, 朱丹玲, 等. 机械通气患者误吸预防管理的证据总结[J]. 护理学报, 2022, 29(13):46-51. DOI: 10.16460/j.issn1008-9969.2022.13.046.
[36] 姜曼, 敖薪. 人工气道管理标准的研究与应用现状[J]. 中华护理杂志, 2016, 51(12):1479-1482. DOI:10.3761/j.issn.0254-1769.2016.12.014.
[37] Mezidi M, Guérin C.Effects of patient positioning on respiratory mechanics in mechanically ventilated ICU patients[J]. Ann Transl Med, 2018, 6(19):384. DOI:10.21037/atm.2018.05.50.
[38] 李伦超, 单凯, 赵雅萍, 等. 2018年欧洲肠外肠内营养学会重症营养治疗指南(摘译)[J]. 临床急诊杂志, 2018, 19(11):723-728.DOI:10.13201/j.issn.1009-5918.2018.11.001.
[39] 陈军, 汪志明. 鼻肠管放置技术在临床营养支持中的规范化应用[J]. 肠外与肠内营养, 2020, 27(4):193-195. DOI:10.16151/j.1007-810x.2020.04.001.
[40] 郑伟, 赵琴, 徐珊玲, 等. 超声监测胃残留量在ICU患者经鼻胃管肠内营养中的应用[J].中国实用护理杂志, 2019(15):1173-1175. DOI: 10.3760/cma.j.issn.1672-7088.2019.15.012.
[41] Bouvet L, Zieleskiewicz L, Loubradou E, et al.Reliability of gastric suctioning compared with ultrasound assessment of residual gastric volume: a prospective multicentre cohort study[J]. Anaesthesia, 2020, 75(3):323-330. DOI:10.1111/anae.14915.
[1] 江雅倩, 陈钊, 徐海燕, 吴前胜, 周雁荣. 心脏手术后急性呼吸窘迫综合征患者俯卧位通气治疗效果及有效时长观察[J]. 护理学报, 2023, 30(9): 60-63.
[2] 陈佳茵, 郭军, 刘宁. 护士职业暴露预防与管理的最佳证据总结[J]. 护理学报, 2023, 30(7): 53-58.
[3] 吕俭霞, 叶丽, 李彬, 吴波, 张含凤, 江庆华, 殷利. 头颈肿瘤放化疗患者吞咽困难预防性训练指导方案的最佳证据总结[J]. 护理学报, 2023, 30(2): 54-59.
[4] 张洁苹, 项丹玉, 高雯霞, 缪园, 王嵌, 杭琳. 加速康复外科理念下肺切除术患者围手术期液体管理的最佳证据总结[J]. 护理学报, 2023, 30(15): 58-63.
[5] 涂英, 杜丹阳, 舒严, 曾涛. 缺血性脑卒中复发预防的最佳证据总结[J]. 护理学报, 2023, 30(11): 41-46.
[6] 陈可塑, 蒋琪霞. 连续床边压力图监测系统预防压力性损伤的研究进展[J]. 护理学报, 2022, 29(8): 31-34.
[7] 陈莹, 胡德英, 丁芳. 基于询问-劝说-转介模式对肿瘤科护士开展预防住院患者自杀培训的研究[J]. 护理学报, 2022, 29(7): 74-78.
[8] 李滢, 陈巧松, 白雅萍, 洪韵婷, 吴玉玲, 戴秋文. 对中高危跌倒患者应用护理专案管理的效果观察[J]. 护理学报, 2022, 29(5): 69-73.
[9] 唐帆, 李亚玲, 罗曼月, 王兆北, 黎张双子, 蔡鹏. 新生儿机械通气患者气道内吸引的最佳证据总结[J]. 护理学报, 2022, 29(24): 38-42.
[10] 马帅, 温慧, 李玉培, 李灵, 郭迎坤, 乔建红. 产科肛门括约肌损伤危险因素及预防措施研究进展[J]. 护理学报, 2022, 29(20): 26-31.
[11] 胡凯利, 杨斯钰, 吴前胜, 周雁荣. 心脏术后患者机械通气时间延长风险预测模型的构建及验证[J]. 护理学报, 2022, 29(20): 60-64.
[12] 卜娜分, 蔡海云, 黄涛, 薛道金, 赵昌勇. 46例脑出血患者神经内镜下颅内血肿清除术的并发症观察及护理[J]. 护理学报, 2022, 29(2): 73-74.
[13] 洪丽微, 侯春怡, 沈香香, 张会锦, 张清, 巨春蓉, 黄丹霞. 肺移植术后出院患者并发症预防与管理的最佳证据总结[J]. 护理学报, 2022, 29(18): 47-52.
[14] 黄赣英, 张晓庆, 朱丹玲, 顾银萍, 钟利君, 姚欢, 吴金艳. 机械通气患者误吸预防管理的证据总结[J]. 护理学报, 2022, 29(13): 46-51.
[15] 邓瑛瑛, 裴华清, 任英, 殷春梅, 文梅, 张小玲. 预防神经外科重症患者PICC相关性静脉血栓的循证护理实践[J]. 护理学报, 2022, 29(11): 36-40.
Viewed
Full text


Abstract

Cited
  Shared   
No Suggested Reading articles found!