呼吸机集束化管理.pptVIP

胃肠减压： 减轻腹部胀气，避免胃液反流 提倡机械通气时应用胃黏膜保护剂硫糖铝预防消化道出血，而不用H2受体阻滞剂或质子泵抑制剂等抗酸剂。 7.预防消化道溃疡 留置胃管： 给予胃肠内营养 尽早停用应激性 溃疡预防药物 8.预防深静脉血栓（DVT） 危重病人发生深静脉血栓的危险性较高 没有进行预防措施前，DVT的发生率约为13-31% Malinoski D，Ewing T，Patel M S，et al. Risk factors for venous thromboembolism in critically ill trauma patients who cannot receive chemical prophylaxis[J]. Injury， 2013， 44(1): 80-85. 8.预防深静脉血栓（DVT） 具体方法： 药物、物理治疗（弹力袜、气压治疗仪） 四、总 结 人工气道护理的质量直接影响着机械通气的疗效及患者的预后，对机械通气患者采取人工气道集束化护理,使最新最可靠的科学依据（循证支持）服务于患者，降低VAP的发生率,提高患者的生命质量。 谢谢 * Why are Ventilated Patients more susceptible to Pneumonia? The ventilated patient’s normal defenses are hampered, blocked or disabled during endotracheal tube-assisted mechanical ventilation by the physical presence of the assistive-breathing device as well as by medications used to keep these patients sedated. * Several organizations and patient safety initiatives, including the Centers for Disease Control and Prevention (CDC), the Association for Professionals in Infection Control and Epidemiology (APIC), Institution for Healthcare Improvement (IHI), and the American Association of Critical Care Nurses (AACN) have developed evidence-based patient-care “bundles” of treatment practices for reducing the occurrence of HAP/VAP. Comprehensive oral hygiene has consistently been recognized as key to preventing HAP and VAP in the hospitalized patient. * * If the intubated, critically ill patient does not receive effective, comprehensive oral hygiene, then dental plaque, hardened bacterial deposits, develop on the teeth within 72?hours. This is followed by emerging gingivitis, gum inflammation and infection, and a subsequent shift from the normal oral flora residents of Streptococcus and Actinomyces species. to increasing numbers of pathogenic aerobic Gram-negative bacilli.  Bundle Care prevent VAP  Alisa 重点 VAP集束化 护理策略 VAP定义 集束化护理 定义 一.VAP概述 呼吸机相关性肺炎(VAP) 经气管插管或气管切开行持续机械通气48小时或者是撤机拔管后48小时内所发生的肺炎 是ICU内最常见的感染 常见病原菌：革兰阴性菌（82%） 定义： 2. VAP的诊断标准(6项) 体温37.5℃ 呼