Patient discomfort and agitation in the ICU: ET tube movement effects

ICU 中患者的不适和躁动：ET 管运动的影响

基本信息

批准号：
8384888
负责人：
Virginia Anne Hamilton
金额：
$ 3.61万
依托单位：
VIRGINIA COMMONWEALTH UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-12-14 至 2013-12-13
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8384888
关键词：
Accounting Address Affect Agitation Air American Anxiety Awareness Bacteria Breathing Care given by nurses Caring Chest Computers Critical Illness Culture Media Data Data Collection Discipline of Nursing Enrollment Extravasation Frequencies Goals Healthcare Healthy People 2010 Hospital Costs Hospitals Hour Incidence Institutes Intensive Care Units Intervention Intravenous Investigation Length of Stay Local Anesthetics Measures Mechanical ventilation Medical Movement Nosocomial Infections Nurses Operative Surgical Procedures Oral Oral cavity Outcome Pain Patients Pharmaceutical Preparations Physical activity Pneumonia Procedures Research Priority Risk Sampling Sedation procedure Side Societies Source Tube United States Update Ventilator cost emotional distress endotracheal experience improved lung pressure microorganism mortality nursing intervention pressure prevent restraint seal sedative statistics

项目摘要

Care of the critically ill patient accounts for approximately 20% of hospital costs in the U.S., and approximately one third of these patients require mechanical ventilation (MV). Ventilator associated pneumonia (VAP) and agitation are frequent complications of mechanical ventilation. Nurses routinely and frequently move the endotracheal (ET) tube with the attached ventilator tubing, from side to side and up and down during care activities, procedures, and patient repositioning but the effect of this frequent ET tube movement on cuff leak, microaspiration and patient comfort is unknown. Since a major factor contributing to VAP is microaspiration around the ET tube cuff, the routine movement of the ET tube and attached ventilator tubing may have a significant effect on cuff leak, and therefore on VAP, warranting further investigation. Healthy People 2010 includes a goal to reduce the incidence of VAP in ICU patients by at least 10%. In an update of research priorities for nursing, the American Thoracic Society addresses an "emphasis on nursing interventions that decrease the incidence of ventilator-associated pneumonia." In addition, the 100,000 Lives Campaign to reduce ICU mortality by saving 100,000 lives, initiated by the Institute for Healthcare Improvement, had at its core, interventions to reduce VAP, such as the VAP bundle. Patients also experience anxiety and discomfort during mechanical ventilation from a variety of sources, but a primary cause of discomfort in these patients is the presence of the ET tube. This discomfort often leads to agitation and may be exacerbated by ET tube movement. Agitation has been shown to increase the length of stay in the hospital from a median of 5 days to 12 days. Reducing agitation and the use of sedation also reduces duration of MV and ICU length of stay, and therefore overall hospital costs. The movement of the ET tube may contribute to both microaspiration (which increases VAP risk) and agitation, increasing the need for sedative therapy. Both of these complications increase mortality and hospital costs. Therefore the primary aim of this study is describe ET tube movement and its effect on ET tube cuff leak, agitation and patient comfort. A secondary aim is to describe the effect of nursing care on the amount, frequency, and type of ET tube movement. A sample of 50 subjects will be enrolled from surgical and medical intensive care units. ET tube movement, cuff pressure, and agitation will be continuously measured and the data downloaded in a bedside computer over a 4 hour data collection period. Patient comfort will be assessed every hour.Nursing activities will be documented using direct observation. Descriptive statistics and ANOVA will be used to determine the effect of ET tube movement on key variables.

照顾重症患者的约20％在美国的医院费用占20％，并且这些患者中约有三分之一需要机械通气（MV）。呼吸机相关肺炎（VAP）和搅动是机械通气的频繁并发症。护士常规经常用附着的呼吸机管从侧面到另一侧移动气管管（ET）管在护理活动，程序和患者重新定位期间，但这种频繁的ET管的效果袖口泄漏，微型诱惑和患者舒适的移动尚不清楚。由于主要因素有助于 VAP是围绕Et Tube Cuff周围的微型抽动，ET管的常规运动并附着呼吸机管可能会对袖口泄漏产生重大影响，因此对VAP有重大影响调查。 2010年健康人的目标是通过AT降低ICU患者VAP的发生率的目标至少10％。在对护理的研究重点的更新中，美国胸部学会解决了 “强调减少呼吸机相关肺炎发生率的护理干预措施。”在此外，通过挽救100,000人的生命来降低ICU死亡率的100,000人的运动，由医疗保健改善研究所的核心是减少VAP的干预措施，例如VAP捆绑包。患者在各种来源的机械通气过程中还会感到焦虑和不适，但这些患者不适的主要原因是ET管的存在。这种不适通常会导致搅动，可能会因et管运动而加剧。搅动已被证明增加了长度住在医院的中位数为5天到12天。减少搅动和镇静的使用减少了MV和ICU住院时间的持续时间，因此减少了医院的总体费用。运动的运动 ET管可能有助于微型诱惑（增加VAP风险）和搅动，从而增加需要镇静剂治疗。这两种并发症都会增加死亡率和住院费用。因此这项研究的主要目的是描述ET管运动及其对ET管袖口泄漏，搅动和病人的舒适。第二个目的是描述护理对数量，频率和 ET管运动的类型。将从外科和医疗重症监护中注册50个受试者的样本单位。 ET管运动，袖口压力和搅拌将连续测量并数据在4小时的数据收集期内在床头计算机中下载。将评估患者舒适每个小时都会使用直接观察记录武器活动。描述性统计和方差分析将用于确定ET管运动对关键变量的影响。