[논문]비용, 인공환기관련폐렴 발생 빈도에 있어서의 개방 기관내 흡인술에 대한 폐쇄 흡인술의 비교

정재우; 최은희; 김진희; 서효경; 최지연; 최재철; 신종욱; 박인원; 최병휘; 김재열

doi:10.4046/trd.2008.65.3.198

비용, 인공환기관련폐렴 발생 빈도에 있어서의 개방 기관내 흡인술에 대한 폐쇄 흡인술의 비교
Comparison of a Closed with an Open Endotracheal Suction: Costs and the Incidence of Ventilator-associated Pneumonia 원문보기

Tuberculosis and respiratory diseases : TRD = 결핵 및 호흡기 질환, v.65 no.3 = no.284, 2008년, pp.198 - 206

정재우 (중앙대학교 의과대학 내과학교실) , 최은희 (중앙대학교병원 중환자실) , 김진희 (중앙대학교병원 중환자실) , 서효경 (중앙대학교병원 중환자실) , 최지연 (중앙대학교병원 중환자실) , 최재철 (중앙대학교 의과대학 내과학교실) , 신종욱 (중앙대학교 의과대학 내과학교실) , 박인원 (중앙대학교 의과대학 내과학교실) , 최병휘 (중앙대학교 의과대학 내과학교실) , 김재열 (중앙대학교 의과대학 내과학교실)

초록
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연구배경: 폐쇄관을 이용한 기관내 흡인은 임상적으로 중한 환자에게 생리적인 이점이 있지만, 병원성 균주에 의한 기관지 내의 집락화가 증가될 수 있다는 보고가 있다. 비용증가는 폐쇄흡인의 또 다른 제한점이다. 본 연구는 폐쇄흡 인 및 개방흡인에 따른 병원균주의 집락화와 인공환기관련폐렴의 빈도와 가격효율성을 비교해보고자 시행되었다. 방 법: 각각 한 달의 간격을 사이에 두고 내과계 중환자실에 입원한 환자들을 대상으로 다중사용 개방흡인, 단일사용 개방흡인, 다중사용 폐쇄흡인을 순차적으로 시행하였다. 비용, MRSA의 기관지내 집락화, 인공환기폐렴의 발생 률을 분석하였다. 결 과: 106명의 환자가 연구 대상으로 포함이 되었고, 이 중 20명의 환자가 다중사용 개방흡인을, 42명이 단일사용 개방흡인을, 44명이 다중사용 폐쇄흡인술을 시행받았다. MRSA의 집락화와 인공환기관련폐렴의 빈도는 세 군간에 의미있는 차이를 보이지 않았다. 입원 일당 소모되는 비용은 다중사용 개방흡인이 $10.58, 단일사용 개방흡인이 $28.27, 다중사용 폐쇄흡인의 경우 $23.76인 것으로 나타났다. 결 론: 다중사용 폐쇄흡인을 매 48시간마다 교환하는 경우 MRSA 집락화와 인공환기폐렴 발생 빈도는 비슷하였고, 기관내 흡인술에 있어서 비용면에서도 효율적인 방법임을 알 수 있었다.

Abstract ▼ AI-Helper

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.

주제어

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문제 정의

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.

가설 설정

The limitations of this study are1) the patients were of small number, 2) this study is sequential design, therefore three groups were not studied at the same time, 3) although the manufacturer recommends that the closed catheter is used during 24 hr, we extended the use of the catheters for 48 hr, 4) physicians ascertaining the outcomes of VAP and MRSA colonization were not blinded, 5) endotracheal suctioning for knowing the colonization was not done regular time and frequency.

제안 방법

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.
Three ways of endotracheal suctioning; multiple-use, open suction catheter-suction catheter was changed 3 times a day (from April 1^st to April 30^th), single-use, open suction catheter (from June 1^st to June 30^th) and multiple-use, closed suction catheter (from September 15^th to October 14^th) were consecutively applied. During each study month, colonization of endotracheal tube by methicillin resistant Staphylococcus aereus (MRSA), VAP incidence rate and the cost of each method were analyzed.
During the study period (one month for each group), VAP developed 4 cases in multiple-use, open suction group, 2 cases in single-use, open suction group and 2 cases in multiple-use, closed suction group. The duration of mechanical ventilation was 168, 172 and 187 days for each group.
During the time of enrollment (one month for each group), MRSA colonized 7 patients in multiple-use, open suction group, 2 patients in single-use, open suction group and 4 patients in multiple-use, closed suction group. Seventy-nine patients discharged from multipleuse, open suction group during the study period and 88 patients from single-use, open suction group and 81 from multiple-use, closed group.
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.
The study consisted of three separated, one month periods. Each month of study was separated by one or one and half month of wash out period.
Each month of study was separated by one or one and half month of wash out period. Three ways of endotracheal suctioning; multiple-use, open suction catheter-suction catheter was changed 3 times a day (from April 1^st to April 30^th), single-use, open suction catheter (from June 1^st to June 30^th) and multiple-use, closed suction catheter (from September 15^th to October 14^th) were consecutively applied. During each study month, colonization of endotracheal tube by methicillin resistant Staphylococcus aereus (MRSA), VAP incidence rate and the cost of each method were analyzed.

대상 데이터

After Institutional Review Board approval, the study was conducted prospectively at the medical ICU of ChungAng University Hospital, Seoul, Republic of Korea from April 1^st to September 14^th, 2006. Patients on mechanical ventilation via artificial airways were included in the study, after informed consent had been provided by their families.
During separated 3 months of study period, 475 patients were admitted in the ICU. Three-hundred sixty one patients were excluded because they did not take mechanical ventilation.
Of 106 patients included in this study, twenty patients received endotracheal suctioning by multiple-use, open suction catheter (suction catheter was changed 3 times a day), 42 by single-use, open suction catheter and 44 by multiple-use, closed suction catheter. Each way of suctioning was consecutively applied for one month period and one or one and half month of wash out period was interposed between each method.
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.
During the time of enrollment (one month for each group), MRSA colonized 7 patients in multiple-use, open suction group, 2 patients in single-use, open suction group and 4 patients in multiple-use, closed suction group. Seventy-nine patients discharged from multipleuse, open suction group during the study period and 88 patients from single-use, open suction group and 81 from multiple-use, closed group. The duration of stay for each group was 588 days, 593 days and 556 days, respectively.
During separated 3 months of study period, 475 patients were admitted in the ICU. Three-hundred sixty one patients were excluded because they did not take mechanical ventilation. Eight patients stayed in the MICU less than 48 hrs and excluded from the analysis.

데이터처리

Physiologic data were examined, using mean±SD. The homogeneity among three groups (multiple-use, open suction, single-use, open suction and multiple-use, closed suction group) in regards to demographic data was evaluated with t-test and Mann-Whitney test. The difference in the colonization by MRSA and the VAP incidence rate were also analyzed by χ² test.

성능/효과

Based on results of this study, multiple-use, closed suctioning has the similar incidence of colonization of MRSA and occurrence of VAP and is a cost-efficient way of endotracheal 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.
Results from this study indicate that overall cost for closed suction system was slightly lower per patient per day based on an average of 32 suctioning procedures per day. Very small difference it may look ($4.

참고문헌 (22)

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상세보기
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저자의 다른 논문 :

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용어 설명: PCR은 세균 특이성이 있는 primer를 이용하여 적은 수의 세균이 있을지라도 쉽게 검출할 수 있는 유용한 방법이며, 이를 이용하여 구강 내 치면세균막이나 타액에서 직접 세균을 검출할 수 있게 되었다[8].

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