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背景:重症监护室(ICU)中,给插管通气的患者吸痰是护理的有机组成部分。在澳大利亚或新西兰,似乎没有公开发表的物理治疗师进行吸痰处理的数据。目的:描述有经验的物理治疗师给予成年患者的吸痰处理及影响因素,患者为澳大利亚和新西兰的ICU中插管通气的患者。调查集中在以下方面:(i)吸痰操作(即打开与关闭吸痰系统);(ii)使用辅助吸痰,如过度氧合、过度充气和生理盐水灌洗;(iii)使用声门下吸痰;(iv)影响吸痰操作的因素。方法:用电子邮件给在ICU工作的有经验的物理治疗师发送电子调查问卷,上述ICU为澳大利亚和新西兰有条件为成年患者插管并行人工通气不少于24小时的ICU。结果:ICU的参与调查率为84.8%(112/132)。绝大多数ICU使用密闭式吸痰系统(97/112,86.6%)。吸痰前,通常对“全部”或“绝大部分”患者使用高浓度氧合(71/112,63.4%),但吸痰后,过度氧合使用率较低(38/112,33.9%)。对“全部”或“绝大部分”患者不常使用过度充气,吸痰前和吸痰后均为22/112(19.6%)。对“全部”或“绝大部分”患者,生理盐水灌洗和声门下吸痰均不常使用(分别为3/112,2.7%和17/112,15.2%)。对吸痰处理影响最大的因素为“个人经验”和“ICU中建立的操作规程”。结论:澳大利亚和新西兰的绝大多数ICU均配备密闭式吸痰系统。因为吸痰过程中,高浓度氧合会最大程度地减少血氧饱和不足,这可能是较大比例的物理治疗师使用这一辅助措施的原因。尽管有证据显示,过度充气能改善肺顺应性,这一辅助措施在吸痰前和吸痰后仍不常使用。尽管有强有力的证据支持,物理治疗师们仍然很少选择声门下吸痰,这表明存在证据-实践差距。
Background: In intensive care units (ICU), suctioning patients intubated for ventilation is an integral part of care. There seems to be no publicly available physical therapist data for sputum aspiration in Australia or New Zealand. OBJECTIVE: Describe the management of sputum aspiration and the impact of an experienced physical therapist on adult patients in intubated patients in the ICU of Australia and New Zealand. The investigation focused on (i) suctioning operations (ie, opening and closing the suctioning system); (ii) using assisted suctioning such as over-oxygenation, hyperventilation and saline lavage; (iii) Sputum; (iv) factors that affect the suction operation. Methods: E-mail an electronic questionnaire to an experienced physical therapist working at the ICU, an ICU for Australia and New Zealand that has the condition to have adult patients undergoing artificial ventilation for at least 24 hours. Results: The ICU’s participation rate was 84.8% (112/132). Most ICUs use a closed suction system (97 / 112,86.6%). Prior to sputum, high concentrations of oxygenation (71 / 112,63.4%) are commonly used for patients with “all” or “most”, but with low rates of over-oxygenation after aspiration (38/112 , 33.9%). Patients were inflated infrequently for either “all” or “most” patients, with 22/112 (19.6%) before aspiration and aspiration. Saline lavage and subglottic aspiration were infrequent (3 / 112,2.7% and 17 / 112,15.2%, respectively) for patients who were “all” or “mostly”. The most influential factors for suction treatment are “personal experience ” and “operating procedures established in the ICU ”. Conclusion: Most ICUs in Australia and New Zealand are equipped with a closed suction system. Because hyperalgesia minimizes oxygen saturation during sputum aspiration, this may be the reason why a larger percentage of physiotherapists use this adjunct. Although there is evidence that hyperinflation can improve lung compliance, this additional measure is not commonly used before and after sputum aspiration. Despite strong evidence support, physical therapists still seldom choose subthreshold aspiration, indicating that there is evidence-practice gap.