Background Elevating the head of bed （HOB） 30°-45° has been widely supported as a means of ventilator associated pneumonia （VAP） prevention. However, it was poorly adhered in clinical practice. This obse...Background Elevating the head of bed （HOB） 30°-45° has been widely supported as a means of ventilator associated pneumonia （VAP） prevention. However, it was poorly adhered in clinical practice. This observational study aimed to investigate the factors impeding this simple practice at the bedside. Methods This prospective study was conducted in 33 Chinese academic hospital intensive care units （ICUs）. HOB angle was measured four times daily at 5-7 hour intervals. The predefined HOB elevation goal was an angle ≥30°. Results The overall rate of achieving the HOB goal was 27.8% of the 8647 measurements in 314 patients during 2842 ventilation days. The HOB goal of ≥3 times/d was consistently achieved only in 15.9% of the cases. Almost 60% of patients had at least one 24 hours period during which the HOB goal was never documented. This low rate of protocol compliance was not associated with acute physiology and chronic health evaluation （APACHE） II score or dependence on vasopressors. In a survey, ＂nurse workload＂ was identified as the most important factor for non-compliance with the HOB goal. In addition, the rates of compliance were significantly different （P 〈0.001） between physicians self-reporting that they either did or did not know the Institutes of Healthcare Improvement （IHI） ventilator bundle. Conclusions Low adherence to a HOB angle of ≥30° was found in this nationwide survey. Nursing workload and lack of knowledge on VAP prevention were important barriers to changin.q this practice.展开更多
目的提升呼吸機通氣病人床頭抬高和氣管插管或氣管切開套管氣囊壓力監測的依從性。方法對護士、護士助理、病室服務員進行理論培訓;每次科會進行總結、提醒;每天進行監督等措施。結果呼吸機通氣病人床頭抬高≧30o依從性合格率由31.2%提...目的提升呼吸機通氣病人床頭抬高和氣管插管或氣管切開套管氣囊壓力監測的依從性。方法對護士、護士助理、病室服務員進行理論培訓;每次科會進行總結、提醒;每天進行監督等措施。結果呼吸機通氣病人床頭抬高≧30o依從性合格率由31.2%提升至57.93%,氣管插管或氣管切開套管氣囊監測合格率由28.22%提升至68.45%,V A P發生率由8.5‰下降至7.85‰。結論每日監測預防VAP措施的執行情況能提高依從性的合格率,使VAP的發生率有所下降。展开更多
文摘Background Elevating the head of bed （HOB） 30°-45° has been widely supported as a means of ventilator associated pneumonia （VAP） prevention. However, it was poorly adhered in clinical practice. This observational study aimed to investigate the factors impeding this simple practice at the bedside. Methods This prospective study was conducted in 33 Chinese academic hospital intensive care units （ICUs）. HOB angle was measured four times daily at 5-7 hour intervals. The predefined HOB elevation goal was an angle ≥30°. Results The overall rate of achieving the HOB goal was 27.8% of the 8647 measurements in 314 patients during 2842 ventilation days. The HOB goal of ≥3 times/d was consistently achieved only in 15.9% of the cases. Almost 60% of patients had at least one 24 hours period during which the HOB goal was never documented. This low rate of protocol compliance was not associated with acute physiology and chronic health evaluation （APACHE） II score or dependence on vasopressors. In a survey, ＂nurse workload＂ was identified as the most important factor for non-compliance with the HOB goal. In addition, the rates of compliance were significantly different （P 〈0.001） between physicians self-reporting that they either did or did not know the Institutes of Healthcare Improvement （IHI） ventilator bundle. Conclusions Low adherence to a HOB angle of ≥30° was found in this nationwide survey. Nursing workload and lack of knowledge on VAP prevention were important barriers to changin.q this practice.
文摘目的提升呼吸機通氣病人床頭抬高和氣管插管或氣管切開套管氣囊壓力監測的依從性。方法對護士、護士助理、病室服務員進行理論培訓;每次科會進行總結、提醒;每天進行監督等措施。結果呼吸機通氣病人床頭抬高≧30o依從性合格率由31.2%提升至57.93%,氣管插管或氣管切開套管氣囊監測合格率由28.22%提升至68.45%,V A P發生率由8.5‰下降至7.85‰。結論每日監測預防VAP措施的執行情況能提高依從性的合格率,使VAP的發生率有所下降。
