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An endotracheal tube with a polyurethane cuff and subglottic secretion drainage reduces the incidence of primary and secondary endogenous ventilator-associated pneumonia
Critical Care volume 12, Article number: P46 (2008)
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.
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.
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.
The endotracheal tube with a polyurethane cuff and subglottic secretion drainage is effective to prevent primary endogenous and secondary endogenous VAP.
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Ramos, L.L., Lecuona, M., Jiménez, A. et al. An endotracheal tube with a polyurethane cuff and subglottic secretion drainage reduces the incidence of primary and secondary endogenous ventilator-associated pneumonia. Crit Care 12 (Suppl 2), P46 (2008). https://doi.org/10.1186/cc6267