Grand Rounds: Grand Rounds: Acute Respiratory FailureAcute Respiratory Failure

Ashley HazelwoodAshley Hazelwood

DemographicsDemographics

78 year old African 78 year old African American FemaleAmerican Female

WidowedWidowed

Baptist Baptist

Never employedNever employed

One DaughterOne Daughter

Height: 64 inchesHeight: 64 inches

Weight: 84.9 KgWeight: 84.9 Kg

Allergy: TetanusAllergy: Tetanus

Full CodeFull Code

Events Leading to HospitalizationEvents Leading to Hospitalization

Total hysterectomy late FebruaryTotal hysterectomy late February

Sent to rehab facility after surgerySent to rehab facility after surgery

Found her unresponsiveFound her unresponsive

Experiencing agonal respirations Experiencing agonal respirations

Taken to hospital and intubated on 3/21Taken to hospital and intubated on 3/21

Risk FactorsRisk Factors

AgeAge

Ovarian Cancer stage IIIOvarian Cancer stage III

Total hysterectomy (abdominal incision)Total hysterectomy (abdominal incision)

HypertensionHypertension

DiabetesDiabetes

AnemiaAnemia

Past Medical HistoryPast Medical History

Right sided Right sided hydronephrosis hydronephrosis secondary to ovarian secondary to ovarian cancercancer

Pyelonephritis Pyelonephritis

GoutGout

HyperlipidemiaHyperlipidemia

Diabetes Diabetes

Hypertension Hypertension

AnemiaAnemia

OsteoarthritisOsteoarthritis

Medical DiagnosisMedical Diagnosis

Acute Respiratory FailureAcute Respiratory Failure

MRSAMRSA

Acute Respiratory FailureAcute Respiratory Failure

Classified as blood gas abnormalitiesClassified as blood gas abnormalities

Occurs rapidlyOccurs rapidly

Gives little time for body to compensateGives little time for body to compensate

Three types: Failure of oxygenation, failure of ventilation, Three types: Failure of oxygenation, failure of ventilation, and failure of bothand failure of both

Failure of OxygenationFailure of Oxygenation

Thoracic pressures are normal Thoracic pressures are normal

Pulmonary blood not adequately oxygenated Pulmonary blood not adequately oxygenated

4 Mechanisms 4 Mechanisms – HypoventilationHypoventilation– Intrapulmonary shuntingIntrapulmonary shunting– Ventilation/perfusion mismatchVentilation/perfusion mismatch– Diffusion defectsDiffusion defects

Failure of OxygenationFailure of Oxygenation

Hypoventilation: Hypoventilation: – Buildup of CO2 Buildup of CO2

displaces O2 displaces O2 (abdominal surgery)(abdominal surgery)

Intrapulmonary shunting:Intrapulmonary shunting:– Blood is shunted past Blood is shunted past

lungslungs– Unoxygenated blood Unoxygenated blood

sent back to left side sent back to left side of heart (atelectasis)of heart (atelectasis)

Ventilation/Perfusion Ventilation/Perfusion mismatch: mismatch: – Degree of a shuntDegree of a shunt– Degree of dead spaceDegree of dead space– Most common cause Most common cause

of hypoxemiaof hypoxemia

Diffusion:Diffusion:– Distance between Distance between

alveoli and capillaries alveoli and capillaries is increasedis increased

Failure of VentilationFailure of Ventilation

Perfusion is normalPerfusion is normal

Ventilation inadequate Ventilation inadequate

Little oxygen reaches alveoli Little oxygen reaches alveoli

Carbon dioxide is retainedCarbon dioxide is retained

Hypoxemia developsHypoxemia develops

2 mechanisms2 mechanisms– HypoventilationHypoventilation– Ventilation/Perfusion mismatch Ventilation/Perfusion mismatch

Failure of VentilationFailure of Ventilation

Hypoventilation: Hypoventilation: – CO2 accumulates in CO2 accumulates in

alveolialveoli– CO2 is not blown offCO2 is not blown off

Ventilation/Perfusion Ventilation/Perfusion mismatch:mismatch:– Increase in volume of Increase in volume of

dead spacedead space– Area no longer Area no longer

participates in gas participates in gas exchangeexchange

SymptomsSymptoms

Hallmark: DyspneaHallmark: Dyspnea

HypoxemiaHypoxemia

HypercapniaHypercapnia

Release of lactic acidRelease of lactic acid

Decreased level of Decreased level of consciousness consciousness

TachycardiaTachycardia

Increased blood pressureIncreased blood pressure

Peripheral Peripheral vasoconstrictionvasoconstriction

ComplicationsComplications

ImmobilityImmobility

Medication side effectsMedication side effects

Fluid and electrolyte Fluid and electrolyte imbalanceimbalance

Hazards of mechanical Hazards of mechanical ventilationventilation

Hazards of mechanical Hazards of mechanical ventilation:ventilation:– AspirationAspiration– VolutraumaVolutrauma– Oxygen toxicityOxygen toxicity– Ventilator associated Ventilator associated

pneumonia pneumonia

MRSA-Methicillin Resistant MRSA-Methicillin Resistant Staphylococcus AureusStaphylococcus Aureus

Bacteria resistant to certain antibiotics. Bacteria resistant to certain antibiotics.

Frequently found in:Frequently found in:– Immunocompromised patients patients– Hospitalized patientsHospitalized patients

Collaboration of CareCollaboration of Care

Nurses Nurses

Nursing StudentsNursing Students

Nursing InstructorNursing Instructor

PhysiciansPhysicians

Respiratory TherapistsRespiratory Therapists

Family Family

Respiratory AlkalosisRespiratory AlkalosisABGs 3/22/08ABGs 3/22/08 ResultResult High/LowHigh/Low RationaleRationale

pH pH 7.547.54 HighHigh

Normal:7.35-Normal:7.35-7.457.45

Mechanical Mechanical ventilationventilation

PCO2 PCO2 34.0 mmHg34.0 mmHg LowLow

Normal: 35-45Normal: 35-45

Increased Increased respiratory raterespiratory rate

PO2 PO2 109 mmHg109 mmHg HighHigh

Normal 80-100Normal 80-100

HyperventilationHyperventilation

HCO3HCO3 20 mmol/L20 mmol/L LowLow

Normal 22-26Normal 22-26

Compensating Compensating for alkalosisfor alkalosis

Laboratory ResultsLaboratory ResultsLabLab Result Result High/LowHigh/Low RationaleRationale

Serum Protein: Serum Protein: PrealbuminPrealbumin

3/25/20083/25/2008

<5.0 mg/dL<5.0 mg/dL LowLow

Normal: 18-25Normal: 18-25

Inflammation r/t Inflammation r/t acute acute respiratory respiratory failurefailure

Coagulation:Coagulation:

PTTPTT

3/25/20083/25/2008

70.9 Sec.70.9 Sec. HighHigh

Normal: 22-35Normal: 22-35

Prolonged Prolonged clotting time r/t clotting time r/t Lovenox Lovenox therapytherapy

MRSA swabMRSA swab

3/27/20083/27/2008

Positive for Positive for MRSA MRSA

AbnormalAbnormal

Normal: Normal: negative swabnegative swab

MRSA infectionMRSA infection

Laboratory ResultsLaboratory ResultsHematologyHematology

3/27/20083/27/2008

ResultsResults High/LowHigh/Low RationaleRationale

WBCWBC 28.7x10^3/mm328.7x10^3/mm3 HighHigh

Normal:4.3-Normal:4.3-10.010.0

Infection, Infection, stress, stress, inflammationinflammation

RBC RBC 3.37x10^6/mm33.37x10^6/mm3 LowLow

Normal:4.0-Normal:4.0-5.405.40

History of History of AnemiaAnemia

HemoglobinHemoglobin 9.3g/dl9.3g/dl LowLow

Normal:12.0-Normal:12.0-16.016.0

History of History of AnemiaAnemia

HematocritHematocrit 29.6%29.6% LowLow

Normal:35-Normal:35-47%47%

History of History of AnemiaAnemia

Laboratory ResultsLaboratory Results

HematologyHematology

3/27/20083/27/2008ResultsResults High/LowHigh/Low RationaleRationale

PlateletsPlatelets 15.315.3 HighHigh

Normal:11.5Normal:11.5-14.5-14.5

History of History of AnemiaAnemia

GlucoseGlucose 175175 High mg/dLHigh mg/dL

Normal:70-Normal:70-110110

DiabetesDiabetes

Diagnostics: X-RaysDiagnostics: X-RaysDiagnosticDiagnostic Date Date FindingsFindings

X-Ray: Placement of X-Ray: Placement of ET tubeET tube

3/213/21 Above Canna(1-2cm)Above Canna(1-2cm)

No infiltrates or No infiltrates or infusionsinfusions

X-Ray: Abdomen Flexi X-Ray: Abdomen Flexi flow placementflow placement

3/223/22 Tip in transport Tip in transport position in duodenal position in duodenal flapflap

X-Ray: Chest, post X-Ray: Chest, post procedure of procedure of thoracentesisthoracentesis

3/253/25 No pneumothorax, No pneumothorax, mild volume loss right mild volume loss right lung, no pulmonary lung, no pulmonary edemaedema

X-Ray: portable chestX-Ray: portable chest

PICC placementPICC placement

3/263/26 Right Upper Extremity, Right Upper Extremity, tip in mid-SVCtip in mid-SVC

X-Ray: ChestX-Ray: Chest 3/273/27 Atelectasis in lower left Atelectasis in lower left basebase

Diagnostics: CT and USDiagnostics: CT and US

DiagnosticsDiagnostics DateDate FindingsFindings

CT: HeadCT: Head 3/213/21 Negative for injuryNegative for injury

Lower Extremity Lower Extremity Doppler ExamDoppler Exam

3/223/22 No deep vein No deep vein thrombosis presentthrombosis present

CT: Chest with IV CT: Chest with IV Contrast, Pulmonary Contrast, Pulmonary embolism protocolembolism protocol

3/243/24 Right Pleural Right Pleural effusion, no effusion, no evidence of evidence of pulmonary pulmonary embolism.embolism.

US: Right US: Right thoracentesis for thoracentesis for right pleural effusionright pleural effusion

3/253/25 200cc straw colored 200cc straw colored fluid aspirated from fluid aspirated from right pleural space right pleural space

MedicationsMedicationsMedicationMedication ClassClass DoseDose RouteRoute FrequencyFrequency RationaleRationale

Insulin Insulin RegularRegular

Short acting Short acting insulininsulin

BG-BG-100/20=# U100/20=# U

SubQ SubQ QID,AC,QID,AC,

BedtimeBedtime

DiabetesDiabetes

Insulin Insulin LantusLantus

Long acting Long acting insulininsulin

15 Units15 Units SubQSubQ QdayQday DiabetesDiabetes

PulmocarePulmocare

Tube Tube FeedingFeeding

Nutrition Nutrition

supplementsupplement

40mL/h40mL/h Per TubePer Tube Continuous Continuous Feeding Q24 Feeding Q24 hourshours

Respiratory Respiratory failurefailure

BenazeprilBenazepril

(Lotensin)(Lotensin)

ACE ACE inhibitorinhibitor

10mg10mg Per TubePer Tube BIDBID HTN Hold if HTN Hold if SBP<100SBP<100

DiltiazemDiltiazem

(Cardizem)(Cardizem)

Ca channel Ca channel blocker blocker

60mg60mg Per TubePer Tube Q6hQ6h tachycardia,tachycardia,

HTNHTN

AmlodipineAmlodipine

(Norvasc)(Norvasc)

Ca channel Ca channel blockerblocker

10mg10mg Per TubePer Tube QdayQday HTN, HTN, TachycardiaTachycardia

MedicationsMedicationsMedicationMedication ClassClass DoseDose RouteRoute FrequencyFrequency RationaleRationale

EsomaprazoleEsomaprazole (nexium)(nexium)

Proton Proton pump pump

inhibitorinhibitor

40mg40mg Per Tube Per Tube add 15 mL add 15 mL of waterof water

QdayQday Prevent Prevent stress stress ulcersulcers

AlbuterolAlbuterol Broncho-Broncho-dilatordilator

4 puffs4 puffs InhalationInhalation

By RTBy RT

Q4hQ4h Respiratory Respiratory FailureFailure

Potassium Potassium ChlorideChloride

ElectrolyteElectrolyte 40 mEq 40 mEq Per Tube Per Tube TIDTID Prevent Prevent hypokalemiahypokalemia

EnoxaparinEnoxaparin

(Lovenox)(Lovenox)

AnticoagulantAnticoagulant, , low low molecular molecular weight weight heparinheparin

40mg40mg SubQ

abdomen

Q24hQ24h Prevent Prevent Deep vein Deep vein

thrombosisthrombosis

MedicationsMedicationsMedicationMedication ClassClass DoseDose RouteRoute FrequencyFrequency RationaleRationale

Piperacillin-Piperacillin-TazobactumTazobactum

(Zosyn)(Zosyn)

Extended Extended

Spectrum Spectrum

penicillinpenicillin

3.375 gm3.375 gm IV solutionIV solution

100mL/h100mL/h

Q6HQ6H MRSA, MRSA, Respiratory Respiratory FailureFailure

LinezolidLinezolid

(Zyvox)(Zyvox)

OxazolidinoneOxazolidinone 600mg600mg IV solutionIV solution

300mL/h300mL/h

BIDBID MRSAMRSA

FurosemideFurosemide

(Lasix)(Lasix)

Loop DiureticLoop Diuretic 40mg40mg Per Tube Per Tube BIDBID Peripheral Peripheral EdemaEdema

LoperamideLoperamide

(Immodium)(Immodium)

PiperidinePiperidine

DerivativeDerivative

2-4mg2-4mg Per Tube Per Tube PRN for PRN for diarrheadiarrhea

DiarrheaDiarrhea

Several soft Several soft stools a daystools a day

AssessmentAssessment

Vital Signs: Vital Signs: – BP:158/62BP:158/62– HR: 101HR: 101– RR: 29RR: 29– O2 sat: 99O2 sat: 99– Temp: 98.4Temp: 98.4– Pain: 0Pain: 0

Intake: Intake: – D5W with 40 D5W with 40

Potassium at 30mL/hPotassium at 30mL/h

Output: Output: – 3 to 4 stools a day3 to 4 stools a day– Zossi PlacedZossi Placed– Urine average of 40-Urine average of 40-

60 mL/h60 mL/h

Assessment: NeurologicalAssessment: Neurological

LOC: LOC: – easily arousedeasily aroused– alert responds to alert responds to

verbal stimuliverbal stimuli– calm, nods to calm, nods to

questionsquestions

Pupils are PERRLA Pupils are PERRLA

Coma Score: Coma Score: – Eyes Open: Spont. 4Eyes Open: Spont. 4

– Best Verbal Best Verbal Response: T (Trach)Response: T (Trach)

– Best Motor Response: Best Motor Response: Obeys Commands 6Obeys Commands 6

– Total: 10TTotal: 10T

Assessment: HEENTAssessment: HEENT

Head: Head: – No lumps, lesions or No lumps, lesions or

tendernesstenderness– SymmetricalSymmetrical

Face: Face: – Symmetrical Symmetrical – No weaknessNo weakness– No involuntary No involuntary

movementsmovements

Eyes: Eyes: – Brows and lashes Brows and lashes

presentpresent– No ptosisNo ptosis– Conjunctiva clearConjunctiva clear– Sclera whiteSclera white– No lesionsNo lesions

Ears: Ears: – No masses, or lesionsNo masses, or lesions– No tenderness or No tenderness or

dischargedischarge

Assessment: HEENTAssessment: HEENT

Nose: Nose: – SymmetricalSymmetrical– No drainageNo drainage– Flexi Flow in left Flexi Flow in left

nostril nostril – No skin breakdownNo skin breakdown

Throat: Throat: – Endotracheal tube in Endotracheal tube in

placeplace– Trachea midlineTrachea midline– No painNo pain– Teeth missingTeeth missing– Mucosa pink and dryMucosa pink and dry

Assessment: MusculoskeletalAssessment: Musculoskeletal

NonambulatoryNonambulatory

Limited range of motionLimited range of motion

Assist with all activities of Assist with all activities of daily livingdaily living

Minimal equal weakness: Minimal equal weakness: upper extremitiesupper extremities

General weakness: left General weakness: left lower extremitylower extremity

Greater weakness: right Greater weakness: right lower extremitylower extremity

Assessment: CardiovascularAssessment: Cardiovascular

Normal heart sounds, S1 Normal heart sounds, S1 and S2 notedand S2 noted

Telemetry: Normal sinus Telemetry: Normal sinus rhythm with premature rhythm with premature atrial beatsatrial beats

No jugular vein distentionNo jugular vein distention

Capillary Refill <3 Capillary Refill <3 secondsseconds

Right and left dorsalis Right and left dorsalis pedis weakpedis weak

Right and left radial 2+Right and left radial 2+

2+ edema in lower 2+ edema in lower extremitiesextremities

1+ edema in hands1+ edema in hands

Assessment: RespiratoryAssessment: Respiratory

Clear lung soundsClear lung sounds

Diminished lung sounds Diminished lung sounds in bases bilaterallyin bases bilaterally

Sputum thick and whiteSputum thick and white

Mechanical Mechanical Ventilation Settings:Ventilation Settings:– CPAPCPAP– PEEP: 5PEEP: 5– FiO2: 30%FiO2: 30%– Pressure Support: 20Pressure Support: 20– Vt: 600Vt: 600

Assessment: GastrointestinalAssessment: Gastrointestinal

Bowel sounds in all four Bowel sounds in all four quadrants quadrants

Abdomen Soft and Abdomen Soft and distendeddistended

Healed abdominal Healed abdominal incision from incision from hysterectomy (midline)hysterectomy (midline)

Impaired swallowing: Impaired swallowing: mechanical ventilationmechanical ventilation

NPO NPO

Flexi Flow NGTFlexi Flow NGT– Continuous feeding: Continuous feeding:

Pulmacore at 40mL/hPulmacore at 40mL/h

Several loose, yellow Several loose, yellow stools a daystools a day

Zossi PlacedZossi Placed

Assessment: GenitourinaryAssessment: Genitourinary

Urine clearUrine clear

Color: pale yellowColor: pale yellow

Urine output > 30mL/hUrine output > 30mL/h

Foley catheter in place and patentFoley catheter in place and patent

Assessment: IntegumentaryAssessment: Integumentary

Excoriated skin on Excoriated skin on buttocks and perineumbuttocks and perineum

Stage 2 breakdownStage 2 breakdown

Braden Score:Braden Score:– Sensory Perception: Sensory Perception:

no impairment 4no impairment 4– Moisture: very moist Moisture: very moist

22– Activity: bedfast 1Activity: bedfast 1– Mobility: very limited Mobility: very limited

22– Nutrition: adequate Nutrition: adequate

33– Friction & Shear: Friction & Shear:

problem 1 problem 1 – Total: 13 Total: 13

interventions in interventions in placeplace

Assessment: IntegumentaryAssessment: Integumentary

Other areas of skin dry, Other areas of skin dry, warm, and intactwarm, and intact

No clubbing No clubbing

PICC on right upper PICC on right upper forearm:forearm:– No infiltration or No infiltration or

inflammationinflammation– Dressing dry and Dressing dry and

intactintact– Patent Patent

Assessment: PsychosocialAssessment: Psychosocial

Patient cried a few times Patient cried a few times from impaired from impaired communication and communication and several accidentsseveral accidents

Most of the time was Most of the time was calm and restingcalm and resting

Had family support at Had family support at bedsidebedside

Daughter visited Daughter visited everydayeveryday

Was there by 0800 every Was there by 0800 every morning morning

Impaired Gas ExchangeImpaired Gas Exchange

Related toRelated to altered oxygen altered oxygen supply secondary to supply secondary to acute respiratory failure.acute respiratory failure.

As Evidenced By:As Evidenced By:– abnormal ABGs abnormal ABGs

(pH:7.54, (pH:7.54, CO2:34.0mmHg, CO2:34.0mmHg, O2:109mmHg, O2:109mmHg, HCO3:29.2mmol/L)HCO3:29.2mmol/L)

– tachypnea (varying tachypnea (varying from 29-33)from 29-33)

– tachycardia (101)tachycardia (101)– anxietyanxiety– dyspneadyspnea– mechanical ventilationmechanical ventilation– decreased RBCs decreased RBCs

(3.37x10^6/mm3), Hgb (3.37x10^6/mm3), Hgb (9.3g/dl), Hct (29.6%)(9.3g/dl), Hct (29.6%)

Goals and InterventionsGoals and Interventions

Goal: Patient will not Goal: Patient will not experience discomfort in experience discomfort in maintaining air exchange maintaining air exchange

Interventions:Interventions:– Monitor VS and I&O Monitor VS and I&O

every hourevery hour– Position every 2 Position every 2

hourshours– Suction as neededSuction as needed– Elevate HOB Elevate HOB – Assess lung sounds Assess lung sounds

every assessmentevery assessment– Assess for Assess for

restlessness and restlessness and change in LOC change in LOC

– Provide ADLs, restProvide ADLs, rest

EvaluationEvaluation

Vital signs and I&O Vital signs and I&O recorded every hourrecorded every hour

Positioned every two Positioned every two hours to promote gas hours to promote gas exchangeexchange

No further ABGs were No further ABGs were drawndrawn

Suctioned twice a daySuctioned twice a day

Lung sounds remained Lung sounds remained clear clear Remained alert and Remained alert and orientedorientedMouth care and bathing Mouth care and bathing was performed was performed Head of bed elevatedHead of bed elevatedO2 oximetry stayed O2 oximetry stayed above 90above 90No signs of respiratory No signs of respiratory distressdistress

Impaired Skin Integrity Impaired Skin Integrity

Related to immobility Related to immobility secondary to mechanical secondary to mechanical ventilationventilation

As Evidenced By:As Evidenced By:– Excoriated buttocks Excoriated buttocks

and perineum, stage 2and perineum, stage 2– Braden score of 13Braden score of 13– InflammationInflammation– DiarrheaDiarrhea– Increased WBC Increased WBC

(28.7x10^3/mm3)(28.7x10^3/mm3)– Low pre albumin Low pre albumin

(<5.0mg/dL) (<5.0mg/dL) – Decreased RBCs Decreased RBCs

(3.37x10^6/mm3), Hgb (3.37x10^6/mm3), Hgb (9.3g/dl), Hct (29.6%)(9.3g/dl), Hct (29.6%)

Goals and InterventionsGoals and InterventionsGoal: Patient will not Goal: Patient will not exhibit any further exhibit any further breakdown.breakdown.

Interventions: Interventions: – Assess skin every Assess skin every

shift assessment shift assessment – Keep skin dry and Keep skin dry and

cleanclean– Turn and position Turn and position

every two hoursevery two hours– Clean accidents Clean accidents

promptly, make sure promptly, make sure zossi is draining zossi is draining with no leaks.with no leaks.

– Apply skin creamApply skin cream– Consult with wound Consult with wound

care nursecare nurse

EvaluationEvaluation

Skin assessed and Skin assessed and documented every eight documented every eight hours.hours.

Patient cleaned promptly Patient cleaned promptly when had accidentwhen had accident

Patient was bathed and Patient was bathed and skin driedskin dried

Turned and positioned Turned and positioned every two hoursevery two hours

No further breakdown No further breakdown occurredoccurred

Impaired Verbal CommunicationImpaired Verbal Communication

Related to artificial airway Related to artificial airway and mechanical and mechanical ventilation secondary to ventilation secondary to respiratory failurerespiratory failure

As Evidenced By: As Evidenced By: – ET tubeET tube– AnxietyAnxiety– Few episodes of Few episodes of

cryingcrying– FrustrationFrustration

Goals and InterventionsGoals and Interventions

Goal: Patient will be able Goal: Patient will be able to communicate her to communicate her needs to the best of her needs to the best of her abilityability

InterventionsInterventions– Establish method that Establish method that

is appropriate for heris appropriate for her– Attempt reading Attempt reading

gesturesgestures– Speak slowly and Speak slowly and

clearlyclearly– Explain proceduresExplain procedures– Expect frustrationExpect frustration– Involve familyInvolve family

EvaluationEvaluation

I used yes/no questions I used yes/no questions to communicate with N.M.to communicate with N.M.

Able to nod to answer my Able to nod to answer my questionsquestions

Every procedure was Every procedure was explained in a clear slow explained in a clear slow mannermanner

Frustration and anxiety Frustration and anxiety were decreased when were decreased when she used the yes/no she used the yes/no responsesresponses

Family was involved in Family was involved in trying to communicate trying to communicate with N.M.with N.M.

Research ArticleResearch Article

A Prospective, Randomized Study of A Prospective, Randomized Study of Ventilator-Associated Pneumonia in Ventilator-Associated Pneumonia in Patients Using a Closed vs. Open Patients Using a Closed vs. Open

Suction System Suction System

PurposePurpose

Verify incidence of nosocomial pneumonia in Verify incidence of nosocomial pneumonia in mechanically ventilated patients having suctioning by mechanically ventilated patients having suctioning by open vs. closed suction method open vs. closed suction method

Methods and Sample SizeMethods and Sample Size

Methods: Methods: – Randomized assay Randomized assay – Parallel groups Parallel groups – Approval was givenApproval was given

Sample:Sample:– Forty seven patientsForty seven patients– Twenty-four received Twenty-four received

open suctionopen suction– Twenty-three received Twenty-three received

closed suctionclosed suction– All older than thirteenAll older than thirteen– Mechanical ventilation Mechanical ventilation

greater than forty eight greater than forty eight hours hours

ResultsResults

Of 24 receiving open Of 24 receiving open suctioningsuctioning– 11 developed 11 developed

ventilator-associated ventilator-associated pneumoniapneumonia

Of 23 receiving closed Of 23 receiving closed suctioning suctioning – 7 developed ventilator-7 developed ventilator-

associated pneumoniaassociated pneumonia

Use of a closed suction Use of a closed suction system did not decrease system did not decrease the incidence compared the incidence compared with the open systemwith the open system

Relation to patient Relation to patient

On mechanical ventilationOn mechanical ventilation

At risk for developing ventilator-associated pneumoniaAt risk for developing ventilator-associated pneumonia

Receiving closed system suctioning Receiving closed system suctioning

Did not acquire pneumonia during my careDid not acquire pneumonia during my care

ReferencesReferences

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Zeitoun, S., Barros, A., Diccini, S. (2003). A prospective, randomized study of Zeitoun, S., Barros, A., Diccini, S. (2003). A prospective, randomized study of ventilator-associated pneumonia in patients using a closed vs. open suction ventilator-associated pneumonia in patients using a closed vs. open suction system. system. Journal of Clinical Nursing, Journal of Clinical Nursing, 12, 484-489. 12, 484-489.

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