重症監護室（ICU) 中，給插管通氣的患者吸痰是護理的有機組成部分。在澳大利亞或紐西蘭， 此前似乎沒有公開發表的物理治療師進行吸痰處理的數據。
澳大利亞和紐西蘭重症監護室中，物理治療師給插管通氣的患者吸痰時採用的方法和輔助措施：一項橫斷面調查
Charissa S.L. Tan Meg Harrold Kylie Hill
目的：描述有經驗的物理治療師給予成年患者的吸痰處理及 影響因素，患者為澳大利亞和紐西蘭的 ICU中插管通氣的患者。調查集中在以下方面：(i) 吸痰操作（即打開與關閉 吸痰系統 ) ；(ii) 使用輔助吸痰，如過度氧合、過度充氣和生理鹽水灌洗；(iii) 使用聲門下吸痰；(iv) 影響吸痰操作 的因素。
方法：用電子郵件給在 ICU 工作的有經驗的物理治療師發送電子調查問卷，上述 ICU為澳大利亞和紐西蘭 有條件為成年患者插管並行人工通氣不少於 24 小時的 ICU。
結果：ICU的參與調查率為 84.8%（112/132)。絕大多數 ICU 使用密閉式吸痰系統（97/112，86.6%)。吸痰前，通常對「全部」或「絕大部分」患者使用高濃度氧合（71/112， 63.4%)，但吸痰後，過度氧合使用率較低（38/112，33.9%)。對「全部」或「絕大部分」患者不常使用過度充氣，吸 痰前和吸痰後均為 22/112（19.6%)。對「全部」或「絕大部分」患者，生理鹽水灌洗和聲門下吸痰均不常使用（分別 為 3/112，2.7% 和 17/112，15.2%)。對吸痰處理影響最大的因素為「個人經驗」和「ICU中建立的操作規程」。
結論：澳大利亞和紐西蘭的絕大多數 ICU 均配備密閉式吸痰系統。因為吸痰過程中，高濃度氧合會最大程度地減少血 氧飽和不足，這可能是較大比例的物理治療師使用這一輔助措施的原因。儘管有證據顯示，過度充氣能改善肺順應 性，這一輔助措施在吸痰前和吸痰後仍不常使用。儘管有強有力的證據支持，物理治療師們仍然很少選擇聲門下吸痰， 這表明存在證據 - 實踐差距。
[關鍵詞] 氣管；衛生保健調查；重症監護；物理治療；吸痰
英文原文：
Approaches and adjuncts used by physiotherapists when suctioning adult patients who are intubated and ventilated in intensive care units in Australia and New Zealand: a cross-sectional survey / Charissa S.L. Tan, Meg Harrold, Kylie Hill // School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia ///
[Abstract]
Objective: To describe suctioning practices and the factors which have shaped these practices, of experienced physiotherapists working with adults who are intubated and ventilated in an ICU across Australia and New Zealand. Areas of investigation focused on: (i) suctioning approach (i.e. open vs. closed system); (ii) use of adjuncts to suctioning such as hyperoxygenation, hyperinflation and saline lavage; (iii) use of subglottic suctioning and; (iv) factors influencing suctioning practices.
Methods: Electronic surveys were emailed to experienced physiotherapists working in ICUs across Australia and New Zealand which had the capacity to intubate and ventilate adult patients for ≥24h.
Results: The participation rate was 84.8% (112/132). Closed suction system was used in most ICUs (97/112, 86.6%). Hyperoxygenation was commonly performed on 'all' or 'most' patients before suctioning (71/112, 63.4%), but less frequently after suctioning (38/112, 33.9%). Hyperinflation was infrequently performed on 'all' or 'most' patients before (22/112, 19.6%) or after suctioning (22/112, 19.6%). Saline lavage and subglottic suctioning were infrequently performed on 'all' or 'most' patients (3/112, 2.7%; 17/112, 15.2%, respectively). 'Personal experience' and 'established practice in the ICU' had the greatest influence on suctioning practices.
Conclusion: Most ICUs in Australia and New Zealand are equipped for closed system suctioning. As hyperoxygenation minimises desaturation during suctioning, there may be scope for a larger proportion of physiotherapists to use this adjunct. The practice of hyperinflation before and after suctioning was uncommon despite the emerging evidence for improved lung compliance with this procedure. Subglottic suctioning was infrequently available as a choice for physiotherapists despite the strong evidence, which suggests an evidence-practice gap.
[Keywords]
endotracheal; health care surveys; intensive care; physiotherapy; suction
作者單位：科廷大學物理治療和運動科學學院，健康科學學院
摘要出處：