PURPOSE: To determine whether intermittent drainage of subglottic secretions decreases bacterial airway colonization and prevention of ventilator pneumonia.
METHODS: DESIGN: A prospective, matched cohort study. SETTING: Medical and surgical intensive care units. PATIENTS: 188 medical and surgical ICU patients who were intubated for ≥ 48 hours were enrolled in the study. Daily quantitative endotracheal aspirate (Q-EA) specimens were obtained. 48 patients were intubated with endotracheal tube with a special port for aspiration of subglottic secretions Mallinckrodt SealGuard Evac ETT; 140 patients were intubated with a conventional endotracheal tube. MEASUREMENTS: A serial quantitative bacterial cultures of endotracheal aspirate were obtained. APACHE II, CCI scores, clinical parameters and chest radiographs were examined . The following clinical outcomes were measured; the incident rates of ventilator-associated pneumonia (VAP), ventilator days, intensive care unit days, hospital days and mortality.
RESULTS: Bacterial airway colonization was not statistically different among the two groups. The bacterial airway colonization was, however,lower in SSD ETT group on the 4th ventilator day (0.95 vs. 2.03, P = 0.09). The VAP rates using both Q-EA ≥ 105 cfu/ml and Q-EA ≥ 106 cfu/ml criteria, VAP incident time, ICU days, hospital days and mortality were not statistically different between these two groups.
CONCLUSIONS: There was no statistical difference in VAP rates, duration of mechanical ventilation or mortality rates in patients receiving intermittent drainage of subglotttic secretion. The study, however, showed that there was a trend of decrease in airway colonization rates during early intubation days in patient undergoing intermittent subglottic secretion drainage.
CLINICAL IMPLICATIONS: The study raises an important question of benefit of SSD ETT in prevention of VAP. The benefit of SSD in mechanically ventilated patients should be carefully evaluated in light of available clinical evidence before incorporating this expensive intervention into routine VAP prevention guidelines.
DISCLOSURE: Donald Craven: University grant monies: Robert Wise Grant, Grant monies (from industry related sources): Pfizer, Consultant fee, speaker bureau, advisory committee, etc.: Pfizer
The following authors have nothing to disclose: Akmal Sarwar, Jana Hudcova, YuXiu Lei, Edward Boroda
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