An endotracheal tube with a polyurethane cuff and subglottic secretion drainage reduces the incidence of primary and secondary endogenous ventilator-associated pneumonia

Introduction

To compare the incidence of ventilator-associated pneumonia (VAP) using an endotracheal tube with a polyurethane cuff, designed to reduce channel formation, and subglottic secretion drainage (ETT-PUC-SSD) versus an conventional endotracheal tube (ETT-C) with a polyvinyl cuff and without subglottic secretion drainage.

Methods

A clinical randomized trial, between 1 March 2006 and 31 October 2006 in a medical–surgical ICU. Were included patients requiring mechanical ventilation during more than 24 hours. Patients were randomized into two groups: one group was ventilated with ETT-PUC-SSD and another group with ETT-C. Throat swabs and tracheal aspirates were taken at the moment of admission and twice a week until discharge. The infections were classified based on thorat flora as: primary endogenous, caused by germs that were already colonizing the throat on the ICU admission; secondary endogenous, caused by germs that were not colonizing the throat on the ICU admission but were acquired during the stay in ICU; and exogenous, caused by germs that were not colonizing the throat.

Results

There were no significant differences between both groups of patients in age, sex, diagnosis groups, APACHE II score, pre-VAP use of antibiotics, paralytic agents, reintubation, tracheostomy, and days on mechanical ventilation. VAP was found in 31 of 140 (22.1%) patients in the ETT-C group and in 11 of 140 (7.9%) in the ETT-PUC-SSD group (P = 0.001). Cox regression analysis showed CET as a risk factor for global VAP (hazard rate = 3.3, 95% CI = 1.66–6.67, P = 0.001), primary endogenous VAP (hazard rate = 5.12, 95% CI = 1.12–23.38, P = 0.04) and secondary endogenous VAP (hazard rate = 2.87, 95% CI = 1.20–6.84, P = 0.02); but not for exogenous VAP.

Conclusion

The endotracheal tube with a polyurethane cuff and subglottic secretion drainage is effective to prevent primary endogenous and secondary endogenous VAP.