ABSTRACT Saline instillation down the endotracheal tube or tracheotomy to aid in secretion removal is a common practice in the intensive care unit (ICU). Normal saline instillation is used to decrease the viscosity of mucous in order to mobilize secretions and aid in suctioning mechanically ventilated patients in the intensive care units. Many respiratory therapists and nurses are currently using saline with endotracheal suctioning without an adequate knowledge of any existing evidence-based research or recommendation to guide the practice. The purpose of this study was to investigate and determine whether saline instillation for bronchial hygiene was beneficial or harmful to the patients and to provide evidence-based guidelines to be followed by healthcare providers in the intensive care units. This is a comprehensive review from the already researched articles on the use of saline instillation down the endotracheal tube for the purpose of mobilizing secretions and suctioning mechanically ventilated patients in the intensive care units (ICU). Databases such as PUBMED, Google Scholar, and Medline were utilized for the review of literature. Keywords: Normal saline, Endotracheal, Tracheostomy, ARDS, Meconium Aspiration, Pneumonia, VAP, Bronchiolitis, Chest Physiotherapy, Intubated, Mechanical ventilation, Bronchoscopy, Bronchoalveolar Lavage INTRODUCTION This paper examines the practice and the usage of endotracheal normal saline instillation prior to suctioning in order to
It has been repeatedly stated that oral care is important in the prevention of ventilator-associated pneumonia (VAP). Endotracheal intubation predisposes patients to developing VAP. The tube acts as a conduit from the mouth to the lungs – a perfect track for bacteria to descend upon. Khezeri, et al. (2014) suggest that “the presence of an endotracheal tube (ETT) inhibits normal coughing, normal swallowing, and the protection of the trachea contact by epiglottis closure.” In addition, an endotracheal tube keeps the patients mouth open – leading to dryness. Bacteria are not washed away by saliva. Also, Landgraf, et al. (2017) mention that the presence of an endotracheal tube in the mouth causes “changes in the oral epithelium” which “might indicate risk for infection in intensive care patients
According to Hunter (2012, p.40) “VAP is a hospital acquired pneumonia that occurs 48 hours or more after tracheal intubation or acute tracheostomisation”. VAP is one of the most common nosocomial infection responsible for one third of mortal respiratory infections in European ICUs (Adib-Hajbaghery et al. 2011).
One of the most important things to maintain a trauma patients airway is ensuring that you have adequate help around (Stephens, 2011). This is important because there are many different tasks that must be delegated in maintaining this persons airway. Some of these processes include opening the airway, suctioning the airway, inserting the proper adjunct, and maintaining
The authors begin their initiation of the research article by stating their reason attention is needed to study the rate of accidental decannulation (AD). Due to the increment in the number of patients receiving protracted mechanical ventilation through artificial airway, much attention is needed to focus on how to reduce the morbidity and mortality rate of accidental decannulation. Not much recognition is given to the complications of AD compared to accidental extubation following translaryngeal intubation (White et al., 2012). According to the authors, the research was triggered by two sentinel events, hence a research for the identification of the causes of AD in LTACH and implementation of strategies to curb the situation.
Even though the consequence of saline instillation on a ventilator patient in the acute care setting is pneumonia or the patient may become hemodynamically unstable, this practice remain contentious, the practice of this procedure will also decrease the oxygenation. (Ayhan, et al., 2015),
Endotracheal tubes containing a tapered cuff have recently been approved by the United States Food and Drug Administration and, based on the findings from in vitro and in vivo studies, are believed to achieve a better tracheal seal (Bowton et al., 2013). This enhanced fit is suggested to reduce the passage of potentially contaminated secretions around the cuff and into the distal airway of mechanically ventilated patients, thereby decreasing the development of VAP. In a study executed by Bowton et al. (2013), researchers examined whether these tapered endotracheal tubes would be more effective in reducing actual rates of VAP. Their study utilized a two-period observational approach in which each study period took place over six of the same calendar months so as to eliminate potential variations in season related to VAP. All adults over the age of 18 who were admitted into a variety of specialized ICUs, whose VAP rates closely resembled the average of all ICUs in the United States, were included in the study. During the first six month period, all endotracheal tubes utilized by the facility contained the standard, barrel-shaped cuff. Following this period, an audit was performed to ensure that all of these tubes were removed and, subsequently, they were replaced with tapered-cuff endotracheal tubes. Additionally, all emergency medical
UE is a serious event that presents as a patient safety and quality improvement concern in the critically ill infant in the NICU. An UE is the premature removal of the endotracheal tube per the patient or staff (accidentally or deliberately) while a patient is receiving invasive mechanical assistance. This occurrence can have significant risk consequences and is considered a potentially life threatening event due to the loss of airway control and mechanical support. Sometimes it is possible for the infant to develop hypercarbia, hypoxia, airway trauma, ventilator-associated pneumonia, intraventricular hemorrhage, and
Ventilator associated pneumonia (VAP) is a hospital acquired infection occurs in the intensive care unit (ICU) for the patients who are on mechanical ventilator. It further complicates the hospital course by extending the length of stay, increase the cost of treatment, and increases the mortality rate. It is estimated that about 1% to 3% patients on mechanical ventilator develops VAP per day. Compared to the previous years, the Chlorhexidine mouth care and other ventilator bundle strategies decreased the VAP rate. Evidence based research studies proved that almost 89.7% reduction in VAP occurs after the implementation of ventilator bundle and other care related to it (Hutchins et al,
Kleinpell, Aitken, and Achorr 2013, recommend that crystalloids solutions, such as normal saline and lactated ringers, or albumin, should be the fluids of choice when initiating fluid resuscitation. Their recommendation is based on a study trial that was conducted to evaluate the effectiveness of artificial colloids. The results indicated no survival benefits when using artificial colloids comparing to crystalloids (Kleinpell, Aitken, and Achorr 2013).
Clinical problem: Oral care and ventilator-associated pneumonia (VAP) is extremely important in all healthcare organizations and has gained increased attention. For this reason, oral care has been introduced in many hospital settings. However, there is not enough evidence on critically ill patients concerning the effect of oral care interventions on the development of VAP. In order to evaluate the effect of oral care on VAP for hospitalized patients, additional studies are required.
From investigation in health practices, ventilator associated pneumonia caught my attention. “Ventilator Associated Pneumonia (VAP) is a leading cause of morbidity and mortality in intensive care units. Most episodes of VAP are thought to develop from the aspiration of oropharyngeal secretions containing potentially pathogenic organisms. Aspiration of gastric secretions may also contribute, though likely a lesser degree. Tracheal intubation interrupts the body’s anatomic and physiologic defenses against aspiration, making mechanical ventilation a major risk for Ventilator Associated Pneumonia. Semi-recumbent positioning of mechanically ventilated patients may help reduce the incidence of gastroesophageal reflux and lead to a decreased incidence of VAP. The one randomized trial to date of semi- recumbent positioning shows it to be an effective method of reducing VAP. Immobility in critically ill patients leads to atelectasis and decreased clearance of bronchopulmonary secretions. The accumulation of contaminated oropharyngeal secretions above the endotracheal tube cuff may contribute to the risk of aspiration. Removing these
Ventilator-associated pneumonia is defined as pneumonia occurring more than 48 hours after patients have been intubated and received mechanical ventilation. Diagnosing VAP requires a high clinical suspicion combined with bedside-examination, radiographic-examination, and microbiologic analysis of respiratory secretions. Aggressive surveillance is vital in under-standing local factors leading to VAP and the microbiologic milieu of a given unit. Judicious antibiotic usage is essential, as resistant organisms continue to plague intensive care units and critically ill patients. Simple nursing and respiratory therapy interventions for prevention should be adopted. (para.2)
For decades prehospital providers have been treating trauma patients by initiating intravenous access and administering crystalloid fluids. The debate has been over what crystalloid fluid to administer for volume replacement, at what amount, and if we should be administering fluids at all. Many products are available and much research has been conducted with results showing that not all fluids are created equal. Some products have the ability to replace volume but provide little more benefit and may actually be harmful. Other products, when administered at much lower volumes, provide far greater benefits and greater potential for a positive outcome for the patient. Most ground ambulances carry Sodium Chloride 0.9% (Normal Saline) even though all research shows that its performance is inferior in comparison to other fluids. In this paper we will look at several recent studies, in which the effects of fluid administration/volume replacement in hypovolemic trauma patients are measured, with a concentrated look at normal saline.
Background: Ventilator-associated pneumonia (VAP) is a common complication of mechanical ventilation after endotracheal intubation. The role of chlorhexidine and tooth brushing has been considered as a clinical intervention to reduce infection rates however evidence to inform this needs appraising. Keywords:
Nursing procedure requires mentoring for circulatory overload and pulmonary edema. The use of crystalloid balanced IV fluids shows lowered mortality and will regulate circulation within an appropriate fashion. (El Solh, Akinnusi, Alsawalha & Pineda, 2008)