Survey of the use and practicalities of subglottic suction drainage in the UK

Introduction

Subglottic secretion drainage (SSD) has been shown to reduce the incidence of ventilator-associated pneumonia (VAP) [1]. We reviewed current UK practice and practicalities surrounding implementation of SSD using a survey.

Methods

We constructed a survey of 10 questions using SurveyMonkey and circulated it via an email link to the Linkmen of the UK Intensive Care Society. Responses were received between August and November 2013.

Results

We had 77 responses. The majority were from doctors (88%) and the rest from nurses. Of respondents, 63% worked in district general hospitals, 28% in teaching hospitals and the rest in specialist units. Overall, 54% of respondents worked in units using SSD. From these responses, the types of patients receiving SSD are summarised in Table 1. One hundred per cent of units used intermittent SSD. Seventy- one per cent of respondents reported that SSD tubes were stored only on their ICU, with 26% reporting availability in acute areas and the rest hospital wide. Twenty-eight per cent of respondents indicated it was unit policy to reintubate patients to facilitate SSD. More than 90% of units had a ventilator care bundle and regularly measured cuff pressures. Overall, 83% of those surveyed thought SSD was beneficial in the prevention of VAP.

Table 1 SSD in specific patient groups (more than one per responder)

Conclusion

Despite specific recommendations from the UK Department of Health [2], only about one-half of respondents work in ICUs where SSD has been adopted. Most studies show benefit in patients expected to be ventilated for greater than 72 hours [1], but most units used SSD in all intubated patients. The reintubation rate to facilitate SSD was also reasonably high, despite a lack of evidence to support this practice. In the vast majority of hospitals, SSD endotracheal tubes are stored only on the ICU and so the need for reintubation may result from a lack of available appropriate tubes at the point of first intubation.