National UK survey: a review of percutaneous tracheostomy and auxiliary subglottic suction port use

Introduction

The tracheostomy is an ancient technique that more recently has developed a percutaneous technique. Percutaneous tracheostomies (PCT) have been shown to be safer and reduce infection, cost and other complications over surgical techniques [1–3]. Ventilator- associated pneumonia (VAP) is a serious complication resulting from the use of endotracheal tubes (ETT) and tracheostomies. Changes in design of these tubes by the addition of a subglottic suction port have been shown to improve VAP rates in mechanically ventilated patients [4],[5]. A large meta-analysis review showed that subglottic drainage reduced the number of days of mechanical ventilation required and reduced the number of days stayed on the ICU [4].

Methods

We contacted all ICUs in the UK by telephone and spoke to the nurse-in-charge to ascertain their normal practice with regards to PCT and subglottic suction use.

Results

We contacted a total of 246 general ICUs, 72% of which we received a response. The average number of beds per ICU from all units who responded was 11. Ninety-eight per cent of ICUs that we questioned did use PCT. For three units, the average bed number per unit was 11 and the other 2% of ICUs who did not use PCT had five beds per unit on average. The proportion of ICUs that employed subglottic suction ports on their ETTs was 43% having on average 11 beds per unit, whilst the proportion of ICUs that did not employ subglottic suction ports was 57%, also with 11 beds per unit on average. Regarding PCT subglottic suction ports, 38% of ICUs did utilise these tubes whilst 62% did not. Of the group of ICUs that did use subglottic suction ports on their tracheostomy tubes, the average beds per unit was 12. Of the group of ICUs that did not use subglottic suction ports on their tracheostomy tubes, the average beds per unit was 10.

Conclusion

Significant differences in practise exist with PCT and subglottic suction ports on tubes. The size of the ICUs in these groups is variable. The larger units are more likely to use PCT over the smaller units. Regarding subglottic suction ports on ETT and tracheostomy tubes, the size of the ICU does not necessarily dictate their use. We propose that all ICUs review their policy on the use of PCT and subglottic suction-assisted tubes to help improve surgical complications, cost, VAP rates and ICU stays.