secretions are indicated by clinica

secretions are indicated by clinical assessment of a patient’s
respiratory status. Indications of a need for suctioning
include audible or visible secretions in the endotracheal
tubing, coarse breath sounds, coughing, increased work
of breathing, arterial desaturation, and/or bradycardia
due to secretions. Suctioning should also be performed
after chest physiotherapy. The instillation of physiological
saline should not be a routine part of endotracheal
suctioning. Instead of using physiological saline, health
care providers should control pulmonary secretions via
hydration, adequate humidification of inspired gas,
mucolytic agents, and effective mobilization of secretions.24
Circuit Changes
Circuit changes should be minimal in infants and
children and should be done only when the tubing is visibly
internally soiled or is malfunctioning.27 Minimal
manipulation of patients and tubing may lead to
decreases in contamination and subsequent pneumonia.27
Practice Recommendations
Bundles used to implement evidence-based clinical
best-practice guidelines are effective when implemented
on a nursing unit.28 The IHI has advocated use of a ventilator
bundle for adults,28 which consists of 4 practices
performed together that collectively are designed to
improve patients’ outcomes. Bundles specifically for
infants and children have not been generally available.
The bundle we propose (Table 5) provides a straightforward
list of nursing interventions to be followed when
caring for children receiving mechanical ventilation.
Implementationof the enhanced prevention bundle can lead to decreased mortality,
improved patient outcomes, decreased length of
stay, and decreased hospital costs.28,29
Pediatric critical care nurses play a vital role in applying
VAP prevention strategies and in identifying recommendations
for improvement. After collecting data in the
PICU, nursing staff can establish a VAP prevention bundle
for children that is based on Table 5. Monthly documentation
of HAIs in collaboration with the infection
control department within the PICU and pediatric inpatient
unit can keep the entire nursing staff abreast of
concerns and potential areas for improvement. Initiating
the use of a VAP prevention bundle provides evidencebased
alerts to adapt nursing care to prevention whenever
a patient being treated with mechanical ventilation is
admitted to or a current patient is intubated in the PICU.
Nurses can also be involved in designing studies that truly
document the effectiveness of bedside protocols. Maintaining
data collection over time with the use of the VAP
bundle will supply critical information on the effectiveness
of these nursing and respiratory interventions in changing
the incidence of VAP in a particular setting.

ผลลัพธ์ (ไทย) 3:

secretions are indicated by clinical assessment of a patient’s
respiratory status. Indications of a need for suctioning
include audible or visible secretions in the endotracheal
tubing, coarse breath sounds, coughing, increased work
of breathing, arterial desaturation, and/or bradycardia
due to secretions. Suctioning should also be performed
after chest physiotherapy. The instillation of physiological
saline should not be a routine part of endotracheal
suctioning. Instead of using physiological saline, health
care providers should control pulmonary secretions via
hydration, adequate humidification of inspired gas,
mucolytic agents, and effective mobilization of secretions.24
Circuit Changes
Circuit changes should be minimal in infants and
children and should be done only when the tubing is visibly
internally soiled or is malfunctioning.27 Minimal
manipulation of patients and tubing may lead to
decreases in contamination and subsequent pneumonia.27
Practice Recommendations
Bundles used to implement evidence-based clinical
best-practice guidelines are effective when implemented
on a nursing unit.28 The IHI has advocated use of a ventilator
bundle for adults,28 which consists of 4 practices
performed together that collectively are designed to
improve patients’ outcomes. Bundles specifically for
infants and children have not been generally available.
The bundle we propose (Table 5) provides a straightforward
list of nursing interventions to be followed when
การดูแลเด็กที่ใช้เครื่องช่วยหายใจ .
พัฒนาปรับปรุงการป้องกันกลุ่มสามารถนำไปสู่การปรับปรุงผลลัพธ์ของผู้ป่วยลดลงจาก

ลดความยาวของพัก และลดต้นทุนของโรงพยาบาล 28,29
กุมารเวชบำบัดวิกฤตพยาบาลมีบทบาทสำคัญในการใช้กลยุทธ์การป้องกันแว็ปและ

ระบุข้อเสนอแนะเพื่อปรับปรุง หลังจากรวบรวมข้อมูลใน picu
, nursing staff can establish a VAP prevention bundle
for children that is based on Table 5. Monthly documentation
of HAIs in collaboration with the infection
control department within the PICU and pediatric inpatient
unit can keep the entire nursing staff abreast of
concerns and potential areas for improvement. Initiating
the use of a VAP prevention bundle provides evidencebased
การแจ้งเตือนปรับการพยาบาลเพื่อป้องกันทุกครั้งที่
ผู้ป่วยได้รับการรักษาด้วยเครื่องช่วยหายใจคือ
ยอมรับหรือผู้ป่วยปัจจุบันจะใส่ท่อช่วยหายใจใน picu .
พยาบาลยังสามารถมีส่วนร่วมในการออกแบบการศึกษาอย่างแท้จริง
เอกสารประสิทธิภาพของโปรโตคอลที่ข้างเตียง การรวบรวมข้อมูลตลอดเวลาด้วย

ใช้ของแว็ปมัดจะจัดหาข้อมูลที่สำคัญในประสิทธิภาพ
พยาบาลเหล่านี้และการแทรกแซงระบบทางเดินหายใจในการเปลี่ยนแปลง
อุบัติการณ์ของ vap ในการตั้งค่าที่เฉพาะเจาะจง