Contenuto dell'articolo principale
Abstract
RIASSUNTO
Introduzione : La manovra di bronco aspirazione è una procedura che espone il paziente critico a modificazioni dei parametri vitali. Le nuove linee guida AARC hanno enfatizzato sia l'importanza dell'identificazione corretta del momento in cui eseguire la procedura, sia l'utilizzo routinario del sistema chiuso. Obiettivo : Applicare le nuove linee guida AARC utilizzando un rilevatore sonoro per l'identificazione della presenza di secrezioni (TBA care©) e l'aspirazione a circuito chiuso ed analizzare l'andamento dei parametri vitali in una popolazione di pazienti cardiochirurgici. Materiali e metrodi: Lo studio è di tipo osservazionale. Sono stati investigati 15 pazienti sottoposti a BPAC, ricoverati in terapia intensiva cardiochirurgia. Sono stati registrati in continuo i seguenti parametri vitali HR, PAS, PAS*HR, ST varie derivazioni, SpO2, PEEP, RRv, TVc in quattro finestre temporali, 5 minuti prima della manovra di Broncoaspirazione, al momento della manovra (momento 0), a 5 minuti dalla stessa e 10 minuti dopo. Risultati : I parametri vitali rimangono sostanzialmente stabili nei quattro step investigati, con minime variazioni (Variazione percentuale durante la manovra rispetto al basale : HR +2,93%, PAS + 5,66%, SpO2 – 0,13%) . Non si sono registrate modificazioni del tratto ST. Si registra un aumento dell'indice di lavoro cardiaco, che però rientra a 5 minuti dall'esecuzione della manovra. Non si sono verificate desaturazioni arteriose. Conclusioni : Le alterazioni dei parametri vitali osservate, seppur minime, suggeriscono di mantenere il massimo monitoraggio emodinamico e respiratorio. Nella popolazione osservata, l'utilizzo di tecnologie per la diagnosi associate al sistema chiuso di broncoaspirazione ha evitato l'insorgenza di complicanze legate alla manovra.
Parole chiave: aspirazione endotracheale, identificazione delle secrezioni, sistema chiuso, ventilazione meccanica, gestione delle secrezioni
ABSTRACT
Introduction: Endotracheal suctioning is a procedure that exposes the patient to critical changes in vital signs. New AARC guidelines have emphasized both the importance of correct identification when to perform the procedure, and the routine use of closed system. Objective: To implement the new guidelines AARC using a sound detector for identifying the presence of secretions (TBA care ©) , closed suctioning circuit and analyze the performance of vital signs in a population of cardiac patients. Methods : The study is observational. Were investigated 15 patients undergoing CABG, cardiac surgery ICU. Were continuously recorded the following vital signs HR, SBP, SBP * HR, ST various leads, SpO2, PEEP, RRV, TVC in four time windows, 5 minutes before the suctioning maneuver at the time of operation (time 0), 5 minutes from the same and 10 minutes later. Results: Vital signs remain stable in the four steps investigated, with minor variations (percent change from baseline during the maneuver: HR +2.93% 5.66% PAS +, SpO2 - 0.13%). There were no ST segment changes. There is an increase in the cardiac work, but within 5 minutes from the execution of the maneuver. There were no arterial desaturation. Conclusions: The observed changes in vital signs, albeit small, suggest to keep the maximum hemodynamic and respiratory monitoring. The use of technologies for the diagnosis associated with the closed system of broncoaspiration has prevented the onset of complications related to the maneuver.
Keywords: endotracheal suctioning, secretion detector, closed system, mechanical ventilation, secretion management
Dettagli dell'articolo
Riferimenti
- AARC clinical practice guideline. Endotracheal suctioning of mechanically ventilated adults and children with artificial airways. American Association for Respiratory Care. Respir Care 1993;38(5):500-504
- AARC Clinical Practice Guidelines, "Endotracheal Suctioning of Mechanically Ventilated Patients With Artificial Airways 2010". Respiratory care, june 2010 vol 55 no 5
- Arroyo-Novoa CM, Figueroa-Ramos MI, Puntillo KA, Stanik-Hutt J, Thompson CL, White C, Wild LR. Pain related to tracheal suctioning in awake acutely and critically ill adults: a descriptive study. Intensive Crit Care Nurs. 2008 Feb;24(1):20-7. Epub 2007 Aug 6.
- Cazorla C, Cravoisy A, Gibot S, Nace L, Levy B, Bollaert PE. Patients' perception of their experience in the intensive care unit. Presse Med. 2007 Feb;36(2 Pt 1):211-6. Epub 2006 Dec 20.
- Cereda M, Villa F, Colombo E, Greco G, Nacoti M, Pesenti A. Closed system endotracheal suctioning maintains lung volume during volume-controlled mechanical ventilation. Intensive Care Medicine 2001;27(4):648-654
- Granja C, Lopes A, Moreira S, Dias C, Costa-Pereira A, Carneiro A; JMIP Study Group Crit Care. Patients' recollections of experiences in the intensive care unit may affect their quality of life. 2005 Apr;9(2):R96-109. Epub 2005 Jan 31.
- Guglielminotti J, Alzieu M, Maury E, Guidet B, Offenstadt G. Bedside detection of retained tracheobronchial secretions in patients receiving mechanical ventilation: is it time for tracheal suctioning? Chest 2000;118(4):1095-1099.
- Johnson KL, Kearney PA, Johnson SB, Niblett JB, MacMillan NL, McClain RE. Closed versus open endotracheal suctioning: costs and physiologic consequences. Crit Care Med 1994;22(4):658-666
- Jubran A, Tobin MJ. Use Of Flow-Volume Curves In Detecting Secretions In Ventilator- Dependent Patients. American Journal of Respiratory and Critical Care Medicine1994;150(3):766-769.
- Liao L, Jollis JC, Anstrom KJ et al Costs for heart failure with normal vs reduced ejection fraction Arch Intern Med 2006; 166: 112-118
- Lucchini A, Asnaghi E, Doni V, Pelucchi S, Villa S, Tundo P, et al. Quando broncoaspirare: nuove tecnologie per la diagnosi. Minerva Anestesiol 2006;72(suppl.1 al N.6):7.
- Lucchini A. Zanella A. Bellani G.Gariboldi R. Foti G. Pesenti A. Fumagalli R. "Tracheal secretion management in the mechanically ventilated patient: comparison between standard assessment and an acoustic secretion detector". Respir Care. 2011 May;56(5):596-603
- Marini J. Acoustic monitoring - super sonics? Critical Care 2009;13(162):2.
- Nashef SA, Roques F, Hammill BG, Peterson ED, Michel P, Grover FL, Wyse RK, Ferguson TB. Validation of European System for Cardiac Operative Risk Evaluation (EuroSCORE) in North American cardiac surgery. Eur J Cardiothorac Surg. 2002 Jul;22(1):101-5
- Rattray J, Crocker C, Jones M, Connaghan J. Patients' perceptions of and emotional outcome after intensive care: results from a multicentre study. Nurs Crit Care. 2010 Mar-Apr;15(2):86-93.
- Roques F, Michel P, Goldstone AR, Nashef SA. The logistic EuroSCORE. Eur Heart J. 2003 May;24(9):882-3
Riferimenti
AARC clinical practice guideline. Endotracheal suctioning of mechanically ventilated adults and children with artificial airways. American Association for Respiratory Care. Respir Care 1993;38(5):500-504
AARC Clinical Practice Guidelines, "Endotracheal Suctioning of Mechanically Ventilated Patients With Artificial Airways 2010". Respiratory care, june 2010 vol 55 no 5
Arroyo-Novoa CM, Figueroa-Ramos MI, Puntillo KA, Stanik-Hutt J, Thompson CL, White C, Wild LR. Pain related to tracheal suctioning in awake acutely and critically ill adults: a descriptive study. Intensive Crit Care Nurs. 2008 Feb;24(1):20-7. Epub 2007 Aug 6.
Cazorla C, Cravoisy A, Gibot S, Nace L, Levy B, Bollaert PE. Patients' perception of their experience in the intensive care unit. Presse Med. 2007 Feb;36(2 Pt 1):211-6. Epub 2006 Dec 20.
Cereda M, Villa F, Colombo E, Greco G, Nacoti M, Pesenti A. Closed system endotracheal suctioning maintains lung volume during volume-controlled mechanical ventilation. Intensive Care Medicine 2001;27(4):648-654
Granja C, Lopes A, Moreira S, Dias C, Costa-Pereira A, Carneiro A; JMIP Study Group Crit Care. Patients' recollections of experiences in the intensive care unit may affect their quality of life. 2005 Apr;9(2):R96-109. Epub 2005 Jan 31.
Guglielminotti J, Alzieu M, Maury E, Guidet B, Offenstadt G. Bedside detection of retained tracheobronchial secretions in patients receiving mechanical ventilation: is it time for tracheal suctioning? Chest 2000;118(4):1095-1099.
Johnson KL, Kearney PA, Johnson SB, Niblett JB, MacMillan NL, McClain RE. Closed versus open endotracheal suctioning: costs and physiologic consequences. Crit Care Med 1994;22(4):658-666
Jubran A, Tobin MJ. Use Of Flow-Volume Curves In Detecting Secretions In Ventilator- Dependent Patients. American Journal of Respiratory and Critical Care Medicine1994;150(3):766-769.
Liao L, Jollis JC, Anstrom KJ et al Costs for heart failure with normal vs reduced ejection fraction Arch Intern Med 2006; 166: 112-118
Lucchini A, Asnaghi E, Doni V, Pelucchi S, Villa S, Tundo P, et al. Quando broncoaspirare: nuove tecnologie per la diagnosi. Minerva Anestesiol 2006;72(suppl.1 al N.6):7.
Lucchini A. Zanella A. Bellani G.Gariboldi R. Foti G. Pesenti A. Fumagalli R. "Tracheal secretion management in the mechanically ventilated patient: comparison between standard assessment and an acoustic secretion detector". Respir Care. 2011 May;56(5):596-603
Marini J. Acoustic monitoring - super sonics? Critical Care 2009;13(162):2.
Nashef SA, Roques F, Hammill BG, Peterson ED, Michel P, Grover FL, Wyse RK, Ferguson TB. Validation of European System for Cardiac Operative Risk Evaluation (EuroSCORE) in North American cardiac surgery. Eur J Cardiothorac Surg. 2002 Jul;22(1):101-5
Rattray J, Crocker C, Jones M, Connaghan J. Patients' perceptions of and emotional outcome after intensive care: results from a multicentre study. Nurs Crit Care. 2010 Mar-Apr;15(2):86-93.
Roques F, Michel P, Goldstone AR, Nashef SA. The logistic EuroSCORE. Eur Heart J. 2003 May;24(9):882-3