• Korean Journal of Adult Nursing
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• v.28 no.6
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• pp.628-636
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• 2016

Purpose: This study examined the effects of a program designed to prevent ventilator-associated pneumonia (VAP) on VAP rate and endotracheal colonization. The program focused on aspiration prevention and oral care. Methods: A nonequivalent control group post-test only design was utilized. One hundred patients admitted to a medical intensive care unit (MICU) or coronary care unit (CCU) were assigned to either a experimental group (n=50) or a control group (n=50). The participants were selected 48 hours following an endotracheal intubation. VAP prevention program given to the experimental group includes keeping the head of the bed to $30^{\circ}{\sim}45^{\circ}$ high, maintaining continuous endotracheal cuff pressure at 25 cm $H_2O$, performing endotracheal suction before change position, and providing oral care with 0.1% chlorhexidine every four hours. The control group received usual care. Data were analyzed using t-test, $x^2$ test, Mantel-Haenszel $x^2$ and Cox proportional harzard regression model. Results: The experimental group showed a lower VAP rate than the control group although the difference was not statistically significant ($x^2=0.79$, p=.375). The experimental group showed lower colonization in tracheal secretion than the control group ($x^2=14.59$, p<.001). Conclusion: Results showed that a VAP prevention program is effective in reducing colonization of tracheal secretion. Therefore, VAP prevention programs are recommended as an ICU nursing intervention.

• Journal of Korean Academy of Nursing
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• v.35 no.2
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• pp.292-302
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• 2005

Purpose: Concept analysis was performed on the behavioral concept of endotracheal suctioning (ETS), to identify the goal, to develop astandardized clinical protocol, to identify the antecedents and consequences, and to differentiate the improper use of ETS. Method: Walker & Avant's concept analysis was employed using clinical guidelines, books and review articles in which the procedures of ETS were written in detail and published in Pubmed within the last 20 years. Result: The macro-goal of ETS was to remove accumulated respiratory secretions. Three defining attributes of ETS were identified; catheter, suctioning and asepsis. Each attribute involved empirical referents, such as the size and depth of the catheter, the suction pressure, duration and method for suctioning. The antecedents of ETS were identical to the clinical evidences for the need of ETS such as the nursing assessment data. The consequences of ETS serve as an evaluation criteria on the effectsof ETS based on the goal of ETS. Conclusion: The concept analysis of ETS demonstrates an example of considering a specific nursing protocol of ETS as a behavioral concept, applying concept analysis to it to identify it's key behavioral components as defining attributes and empirical referents and then developing and applying the standard ETS protocol.

• Journal of Chest Surgery
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• v.24 no.10
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• pp.1000-1004
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• 1991

Children`s small airway precludes the use of standard methods of bronchial separation. So, we performed the posterior thoracotomy under the prone position in 3 cases to avoid endobronchial gravity spillage of secretion and infected debris from the diseased lung to the contralateral sound lung. The advantages of the posterior thoracotomy under the prone position was discussed. In two cases, empyema with total collapse of left lung and congenital cystic adenomatoid malformation [CCAM] of right lung, copious secretion was spilled through the endotracheal tube but could be removed successfully by the endotracheal suction. In the third case of bilateral peripleural abscess, bilateral posterior thoractomy was done without position change. All procedures were performed without any technical difficulty and complication.

• Tuberculosis and Respiratory Diseases
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• v.65 no.3
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• pp.198-206
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• 2008

Background: Tracheobronchial suctioning using the closed suctioning system has physiological benefits for critically ill patients. Despite these benefits, there are concerns about increased colonization of tracheobronchial tree by pathogenic organisms. The cost is another hinder to the introduction of closed suction system. The aim of this study was to evaluate the incidence of colonization and ventilator associated pneumonia and the cost-effectiveness of closed suction compared with open suction. Methods: During separated one month period, patients admitted MICU were cared by multiple-use, open suction, single-use, open suction and multiple-use, closed suction method, consecutively. Costs, colonization of tracheobronchial tree by MRSA and the incidence of ventilator-associated pneumonia (VAP) were analyzed. Results: One-hundred and six patients were enrolled. Twenty patients were treated with multiple-use, open suction, while 42 and 44 patients were cared with single-use, open catheter and multiple-use, closed catheter, respectively. Colonization by MRSA and the incidence of VAP were not different among three ways of suctioning. The overall costs per patient per day for suctioning were $10.58 for multiple-use, open suction, $28.27 for single-use, open suction and $23.76 for multiple-use, closed suction. Conclusion: Multiple-use, closed suctioning, when suction catheters were changed every 48 hrs, has the similar incidence of colonization of MRSA and occurrence of VAP and is a cost-efficient way of endotracheal suction.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.10 no.1
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• pp.96-107
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• 2003

Objective: The purpose of this study was to identify the effects of tracheal suction and the effects of different methods of bronchodilator inhalation (Ultrasonic nebulizer: MDI puff, MDI puff with spacer) in VSD surgery patients. Material & Method: From June 2001 to March 2002, sixty consecutive patients were randomly assigned to a control group (n= 15), ultrasonic nebulizer group (n=15), metered dose inhalation (MDI) puff group (n=15) and MDI with spacer group (n=15). Vital signs (HR, BP, CVP), ABGA and pulmonary functions were measured before suction (baseline for suction), after suction, 15 minutes after suction (base of bronchodilator inhalation), 30 minutes after bronchodilator inhalation, and 2 hours after bronchodilator inhalation. Stastistical analysis was performed using SPSS software. Repeated measure ANOVA was used to examine the effects of tracheal suction. One way ANOVA with Bonferroni's correction and multiple range test (the least significant difference test) were used to examine the effects of albuterol inhalation. Result: 1. Heart .ate increased significantly immediately after suction (p<.01) and recovered 15 minutes after suction. 2. $PaO_2$ and PH decreased significantly immediately after suction (p<.05) and $PaO_2$ recovered 15 minutes after suction. $PaCO_2$ increased immediately after suction and significantly 15 minutes after suction (p<.01). But changes in vital signs and ABGA were within the normal range. 3. Tidal volume decreased significantly 15 minutes after suction (p<.05). 4. Changes of HR and tidal volume were greater in the nebuizer group compared to the other groups (p<.05) 30 minutes after bronchodilator inhalation and recovered 2 hours after bronchodilator inhalation. 5. Changes of airway deadspace was greater in the nebulizer group compared to the control group and MDI puff group 30 minutes after albuterol inhalation (p<.05) and at 2 hours (p<.01). Conclusion: Tracheal suction did not have significant effect on vital signs and pulmonary functions after OHS. Although the methods of bronchodilator inhalation did not showed any significant difference on pulmonary function, the nebulizer method increased $PaO_2$ (20%) and tidal volume transiently. If the patient needs bronchodilator inhalation with bronchospasm after OHS, the nebulizer method is the best choice. More study on the effects of bronchodilator inhalation in bronchospasm group is needed.

• Child Health Nursing Research
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• v.5 no.2
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• pp.198-210
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• 1999

The goal of respiratory management in high risk infants is to maintain proper oxygenation by supporting respiration, therefore to minimize the secondary complications and to promote the maximum growth and development. While on artificial ventilator to achieve this goal, the infants require endotracheal suctioning(ETS) to remove lung secretions. However, the negative effects of ETS in neoates have been documented and include hypoxia, bradycardia, mucosal damage, increased intracranial pressure, and death result. The purpose of the study was to investigate how ETS is currently performed in NICU, which would be beneficial to develop the standardized ETS protocol and to apply it to these population. A national-wide survey on clinical protocol of ETS was performed to 149 neonatal nurses with the average of 3 years and 6 months experience in neonatal nursing, 34.2% of whom was bachelor in nursing. The results showed that about 89% of the nurses initiate En primarily based on the need of the subjects. The aseptic regulation on ETS was used in 83.9% of the subjects. There was no regulation on the length of catheter in 32.9% and on ID/OD ratio in 17.4%. Many nurses administered hyperoygenation/hyperinflation/hyperventilation based on personal knowhow, rather than scientific rationals (77.2%, 40.9%, 75.2%, retrospectively). About 41% of the nurse regulate subjectively the suction power, while 73.8% of them rotate the sub ject's head during suctioning and the half of the nurses was favorable in adapting the closed-suctioning protocol. With the findings of the study, the current clinical application of E% in neonates appears to be based on adult care practices, or personal preference, rather than scientific validation of the safety and effectiveness of the procedure. This study support the needs for developing and applying the standardized ETS protocolin conjunction with the consideration given to the physiologic characteristics of the neonates in respiratory distress.

• Journal of Korean Academy of Nursing
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• v.44 no.2
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• pp.149-158
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• 2014

Purpose: This study was conducted to compare effects of open and closed suctioning methods on lung dynamics (dynamic compliance, tidal volume, and airway resistance) and hypoxemia (oxygen saturation and heart rate) in mechanically ventilated patients. Methods: This study was a cross-over repeated design. Participants were 21 adult patients being treated with endotracheal intubation using a pressure-controlled ventilator below Fraction of Inspired Oxygen ($FiO_2$) 60% and PEEP $8cmH_2O$. Data were collected at baseline and 1, 2, 3, 4, 5, and 10 minutes after suctioning. Data were analyzed using two-factor ANOVA with repeated measures on time and suctioning type. Results: Effects of the interaction between suction type and time were significant for oxygen saturation and heart rate but not significant for dynamic compliance, tidal volume, or airway resistance. Prior to performance of suctioning, tidal volume and oxygen saturation were significantly lower, but airway pressure and heart rate were significantly higher using the closed suctioning method as compared with the open suctioning method. Conclusion: For patients on ventilator therapy below $FiO_2$ 60% and PEEP $8cmH_2O$, open suctioning performed after delivery of 100% $FiO_2$ using a mechanical ventilator may not have as much negative impact on lung dynamics and hypoxemia as closed suctioning.

• Korean Journal of Adult Nursing
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• v.18 no.5
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• pp.718-726
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• 2006

Purpose: The purpose of this study was to investigate differences between a pulmonary aspiration group and a non-pulmonary aspiration group in glucose concentration of tracheal secretions by measuring time and feeding methods. Method: The subjects were 36 ICU patients who were receiving formula via nasogastric tubes and had endotracheal tubes or tracheostomy tubes. Tracheal secretions were collected by connecting suction traps to a suction catheter in three different times(within 1 hour after feeding, between 1 to 2 hours after feeding, and between 2 to 3 hours after feeding) for 2 days, overall six times. Glucose concentration of tracheal secretions was measured with the glucometer(Accucheck II). Results: Glucose concentration of tracheal secretions increased in progression after feeding. The mean of specimens collected last(between two to three hours after feeding) was shown to be the highest value(M=61.61mg/dl) in the pulmonary aspiration group. Significantly(p=.000) more subjects(94.44%) in the pulmonary aspiration group received formula via a 50cc syringe than those in the non-pulmonary aspiration group(22.22%). Conclusion: Critically ill patients may need more time for head-elevation after tube feeding to prevent pulmonary aspiration. In practice, enteral formula should not be given the patients via a $50_cc$ syringe anymore, instead a feeding bag or infusion pump should be used to prevent pulmonary aspiration.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.21 no.3
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• pp.226-234
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• 2014

Purpose: This study was done to present guidelines for deciding appropriate times for measuring blood pressure (BP) in patients with neurological disorders who had surgery due to brain damage. Method: It was a repeated measures-experimental research on time variants in BP after nursing care. SBP (Systolic BP) and DBP (Diastolic) were measured every 2 minutes up to 5 times using an EKG patient monitor. Measured data were analyzed using repeated measures ANOVA and paired t-test. Results: For suctioning, there were significantly higher differences for SBP averages after 2 min. (138mmHg, p<0.01) and 4 min. (133mmHg, p<0.01) compared to before suctioning (120mmHg). For position change, there were significant differences in SBP averages after 2 min. (136mmHg, p<0.01) and 4 min. (130mmHg, p=0.01) compared to before changing position (121mmHg). For position change followed by suctioning there were significant differences in SBP averages after 2 min. (136mmHg, p<0.01), 4 min. (136mmHg, p<0.01) and 6 min. (125mmHg, p=0.003) compared to before the interventions (121mmHg). Conclusions: Results indicate that there are significant differences in SBP and DBP over time during nursing interventions, suggesting clinical measurement of BP after 6 min. or 8 min. be done for patients with neurological disorders in neurosurgery clinics.

• Journal of Korean Biological Nursing Science
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• v.6 no.2
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• pp.19-30
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• 2004

The purpose of this study was to compare chest percussion with chest vibration in brain injury patients. 30 patients in SICU of one general hospital in T city were randomely divided by 3 groups and the arterial oxygen tension(PaO2) and the retained secretion were measured. The chest vibration was done among the first group, the chest vibration by hand after the chest percussion was done among the second group and the mechanical chest vibration after the chest percussion was done among the third group. The data was analyzed using SPSS 7.0(5% significance) and the results are below. 1) It was adopted the hypothesis that the amount of retained secretion of endotracheal suction after stopping the actions among the first, second and the third groups is different from each other.(F=41.62, p=0.00) 2) It was rejected the hypothesis that the arterial oxygen tension(PaO2)s are different from each other among the first, second and third group.(F=1.22, p=0.31) The amount of the retained secretion after chest percussion, chest vibration by hand or mechanical chest vibration was significantly different from each other. Therefore, chest physiotherapy could be regarded as the effective nursing intervention for the unconscieus patients who have the inappropriate airway cleaness and it was more effective to be together than to be alone.