Effect of subglottic secretion drainage for preventing ventilator-associated pneumonia

Introduction

We aimed to assess the effect of continuous drainage of subglottic secretion in the prevention of ventilator-associated pneumonia (VAP) in patients requiring prolonged mechanical ventilation for more than 48 hours in the ICU as a prospective, randomized, controlled study.

Methods

Our study was performed with a document from the ethics committee and written informed consent from the relatives of patients between April 2011 and February 2012 in our 14-bed ICU. Fifty-four patients whose mechanical ventilation requirements were expected to be longer than 72 hours were included in our study. Patients were randomly divided into two groups. These were formed as the group using a conventional intubation tube (Group C) and the group using an intubation tube allowing aspiration of subglottic secretions (Group S). In Group S, continuous subglottic aspiration occurred under constant pressure with a special device. In both groups, the cuff pressure was maintained at a constant pressure of 20 to 30 using a digital cuff pressure device [1].

Results

In Group C, VAP was developed in 10 (35.7%) of 28 patients. In group S, VAP was developed in five (21.7%) of 23 patients. In both groups when compared according to the development of VAP, no statistically significant differences were detected (P = 0.276). However, in the first 5 days the development of VAP was significantly higher in Group C (respectively, 4.3% vs. 25%, P = 0.046). The growth rate of VAP (VAP number/ventilator-day × 1,000) in Group C was 17.48, while in Group S it was 11.62. Between the groups there were no statistically significant difference according to ICU mortality, length of ICU stay and length of hospital stay (P ≥ 0.05).

Conclusion

This prospective randomized controlled study demonstrated that the incidence of VAP (especially early development of the VAP) with continuous aspiration of subglottic secretions without creating any undesirable clinical damage in the airways was significantly reduced.