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发表于 2008-12-17 14:52:10
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[h1]还有个问题，是说为什么bundle里没有声门下吸引这项措施？[/h1]
Why is subglottic suctioning not included in the ventilator bundle?
Subglottic suctioning may be a very effective therapy for reducing the incidence of VAP. Recent studies have demonstrated efficacy of this approach. A meta-analysis assessed the effect of subglottic secretion drainage on the incidence of VAP and found that subglottic suctioning reduced the incidence of VAP by nearly half (risk ratio 0.51; 95% CI 0.37-0.71). Nevertheless, part of the aim of a bundle strategy is to implement solutions that are rapidly and readily available to hospitals. In addition, there is a tendency among providers to do all possible interventions, when a select few might be effective to minimize risks. Given the experience with the ventilator bundle that demonstrates near zero rates of VAP for prolonged periods of time with the 4 strategies that are included in the bundle when reliably applied, other strategies may not be necessary. In addition, we encourage teams to maximize their implementation of the existing items in the ventilator bundle before adding other approaches. The solution may in fact be doing just these items very well, instead of doing additional items fairly well.
Dezfulian C, Shojania K, Collard HR, et al. Subglottic secretion drainage for preventing ventilator-associated pneumonia: a meta-analysis. Am J Med. 2005; 118:11.
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