Abstract
Objective. The study focused on the nursing strategies of patients with ventilator-associated pneumonia (VAP) and multicriteria decision analysis (MCDA) in nursing supervision, so as to improve the survival rate and prognosis of patients with VAP. Methods. 200 patients of the database in the ICU who required mechanical ventilation were selected as research subjects. They were divided into control group and intervention group according to different nursing measures. The incidence of VAP was compared between the two groups, and 15 experts were consulted on the prevention measures of VAP. On the basis of ARIMA-GARCH mathematical modeling, using the method of multicriteria decision analysis, the cluster nursing strategy for ventilator-associated pneumonia patients was developed and verified. Results. In the control group, of the 34 patients infected with VAP, Gram-positive bacteria were detected in 11 cases, including 6 cases of Streptococcus pneumoniae, 3 cases of Escherichia coli, and 2 cases of golden yellow Staphylococcus. Gram-negative bacteria were detected in 10 cases, including 5 (50%) cases of Acinetobacter baumannii, 2 cases of Klebsiella pneumoniae, 2 cases of Brucella Bacillus, and 1 case of Pseudomonas aeruginosa. In the intervention group, 18 cases were diagnosed with VAP, including 4 (44.4%) cases of bacterial infection, 3 (44.4%) cases of virus infection, and 2 (22.2%) cases of fungal infection. According to the opinions of the 15 experts, a total of 6 bundled measures were adopted to prevent VAP, including 0.1% chlorhexidine for oral care; strict implementation of hand hygiene; the daily wake-up for spontaneous breath training and extubation assessment; continuous subglottic suction; raising the bed head by 30°–45°; and nasal feeding through the nasal tube without special condition. Conclusion. There are many factors that affect the occurrence of VAP in mechanically ventilated patients in the ICU, and the imperfect measures of bundles of care are the main one. The implementation rates of distinct intervention strategies are different. The implementation rate of 2 measures is lower than 95%, which are the continuous subglottic suction and daily wake-up for spontaneous breath training and extubation assessment.
Highlights
In clinic, mechanical ventilation is increasingly used to maintain patients’ lives
86 people were older than 65 years old (86%), more than 80 in the intervention group (80.0%); 58 people (58.0%) had smoked before, more than 54 (54%) in the observation group; and 46 people had a history of diabetes (46.0%), less than 50 (50%) in the intervention group (Table 1)
Comparison of the Age Distribution. ere was no statistically significant difference in the distribution of age and APACHE infection control; (II) scores between the two groups of patients, as shown in Figure 1. ere were 10 people aged less than 45 years, including 4 in the control group and 6 in the intervention group
Summary
The infection rate of ventilator-associated pneumonia (VAP) has been increased year by year [1]. VAP refers to pneumonia that occurs in patients with artificial airways after 2 days of mechanical ventilation (within 48 hours after weaning and extubation) [2]. 5%–15% of patients with mechanical ventilation may develop VAP, and the mortality rate is as high as 10% [3]. There is an increasing probability to develop VAP for patients with mechanical ventilation, leading to an increased mortality rate and extended mechanical ventilation time and time spent in the ICU [5]. E bundles of care can more effectively reduce the risk of infection and have become an important means to prevent the occurrence of VAP.
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