2019 Fiscal Year Final Research Report
Safe and effective of airway clearance techniques for patients with severe respiratory failure
| Project/Area Number |
16K20746
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| Research Category |
Grant-in-Aid for Young Scientists (B)
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| Allocation Type | Multi-year Fund |
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| Research Field |
Clinical nursing
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| Research Institution | Ibaraki Christian University (2018-2019)
University of Tsukuba (2016-2017) |
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Principal Investigator |
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| Project Period (FY) |
2016-04-01 – 2020-03-31
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| Keywords | 人工呼吸 / 気道クリアランス / 気管吸引 / 胸郭圧迫法 |
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| Outline of Final Research Achievements |
Closed suction was performed on rabbits with severe lung injury, and it was found that suction pressure of about 300 mmHg had little effect on oxygenation compared with suction pressure recommended by the guidelines so far. In the prospective observational study, closed suctioning was deeper and higher suction pressure than recommended by the guideline, but there were few complications and severe adverse events did not occur. Hard and brief manual rib cage compression combined with closed suctioning was safe and led to improvement of mucus clearance; however, no effectiveness was confirmed with regard to oxygenation and ventilation. Airway clearance requires some patient cooperation and understanding. We performed a risk factor analysis on delirium and found that excess fluid was one of the risks.
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| Free Research Field |
クリティカルケア看護
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| Academic Significance and Societal Importance of the Research Achievements |
ガイドラインでは吸引圧を150mmHgまでとしているが、これは古典的な開放式吸引システムを使用によるデータに基づいている。現在ICUでは、閉鎖式吸引と呼ばれる気管吸引システムが主である。このシステムでは人工呼吸器からの送気、圧サポートにより肺虚脱が起こりにくいとされる。従って閉鎖式吸引では、ガイドライン推奨吸引圧より高い圧で気管吸引を実施しても合併症は起こりにくいことが考えられる。この仮説に基づき動物実験、観察研究を実施し、ガイドライン推奨よりも高圧でも大きな合併症が観察されないことを明らかにした。また気道クリアランス法に関してデータの少ない胸郭圧迫法の効果に関しても明らかにしている。
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