運用以實證為基礎健康照護措施降低呼吸器相關肺炎發生率之探討

Evidence-based Care on the Reduction of Ventilator Associated Pneumonia

10.6530/YYN.2014.8(2).06

林利珍(Li-Chen Lin)；陳慧如(Hui-Ju Chen)；黃品惟(Pin-Wei Huang)；林宗坤(Tsung-Kun Lin)

實證健康照護 ； 呼吸機相關肺炎 ； evidence-based health care ； VAP

源遠護理

8卷2期（2014 / 08 / 01）

30 - 37

繁體中文

隨著實證健康照護觀念的發展，臨床實務醫療照護已將實證文獻的論述，做為臨床照護指引的決策依據，如何在臨床上有效地運用實證醫學文獻，實際應用在臨床照護，儼然已成為醫療工作團隊執行臨床工作之重要方向。呼吸器相關肺炎的發生率一直是接受機械換氣治療後病人常見的合併症，醫療團隊透過實證文獻的查證發現，多數研究證據均強調口腔衛生或口腔內抽吸的重要性，且提及床頭搖高30到45度，是有效降低呼吸機相關感染之重要措施。因此，經由實證步驟確認臨床問題，進一步查證實證文獻並完成文獻評讀，將結果與醫療團隊及家屬分享討論，於2011年7月實際將「維持床頭高度大於30度」的措施，執行在呼吸照護中心臨床照護上。經過一年的執行結果發現，呼吸器相關肺炎感染發生率有效下降了31.7%（千分之1.26→千分之0.86），住院天數縮短3.49天（15.08%），並將此護理措施納入標準技術中，平行推廣，以提升護理照護品質。

Ventilator-associated pneumonia (VAP) is the most common infection in mechanically ventilated patients and is associated with increased mortality, morbidity, duration of mechanical ventilation, and length of intensive care unit stay. The development of clinical care guidelines, practice and decision making should be based on evidence. Literature review supported the bundle of oral hygiene, oral suction, and the semirecumbent position (head of bed elevated at 30-45°) in mechanical ventilation patients were effective in the prevention of VAP. Based on evidence, the Respiratory Care Center in a metropolitan hospital decided to incorporate the semirecumbent＞30° position in the care of all ventilated patients. One year after implementation, the VAP incidence decreased by 31.7% (1.26 per mille→0.86 per mille) and hospital stay was reduced by 3.49 days (15.08%). Semirecumbent＞30° positioning for mechanically ventilated patients is recommended as a standard of practice in intensive care units.