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Effect of continuous aspiration of subglottic secretions on the prevention of ventilator-associated pneumonia in mechanically ventilated patients
Critical Care volume 12, Article number: P47 (2008)
The objective was to evaluate the effect of continuous aspiration of subglottic secretions (CASS) on the prevention of ventilator-associated pneumonia (VAP) in mechanically ventilated patients.
Patients ventilated mechanically in the ICU from October 2004 to April 2006 were randomly divided into two groups: one group of patients was treated with CASS and the other group of patients was not (NASS group). The CASS was performed immediately after admission in the CASS group of patients. The diagnosis of VAP was made based on the clinical presentations, and the evaluation of VAP was done using the simplified version of the Clinical Pulmonary Infection Score. The general status of the patients, days of ventilated treatment, the volume of daily aspirated subglottic secretions, the morbidity and timing of VAP, days of stay in ICU and mortality within 28 days of hospitalization were recorded.
One hundred and one patients were included in the study. There were 48 patients in the CASS group who were treated with mechanical ventilation for longer than 48 hours, and 43 patients in the NASS group. The median volume of aspirated subglottic secretions within the first 24 hours in the CASS group of patients (48 cases) was 28.8 ml. The morbidity of VAP in the CASS and NASS groups of patients was 25.0% and 46.5%, respectively (P = 0.032), and the length of time before the onset of VAP in these two groups of patients was 7.3 ± 4.2 days and 5.1 ± 3.0 days, respectively (P = 0.088). There was a significant increase in the percentage of Gram-positive cocci from the lower respiratory tracts in the NASS group of patients compared with that in the CASS group of patients (P = 0.004). In the CASS group of patients, the volume of the first daily aspirated subglottic secretions in patients with VAP was significantly less than that in patients without VAP (P = 0.006). The morbidity of VAP in patients with the failed early aspiration (volume of first daily aspirated secretions ≤ 20 ml) was significantly higher than in patients who were aspirated effectively (P < 0.01). The length of mechanical ventilation time in patients with VAP was significantly longer than that in patients without VAP (P = 0.000). The inhospital mortality in patients with VAP was significantly higher than that in patients without VAP (P = 0.009), and mortality in the 28 days after admission in patients with VAP was significantly higher than that in patients without VAP (P = 0.035).
Effective continuous aspiration of subglottic secretions could significantly reduce the morbidity of early-onset VAP, and, accordingly, may decrease the mortality of critically ill patients.
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Yang, C., Qiu, H. & Zhu, Y. Effect of continuous aspiration of subglottic secretions on the prevention of ventilator-associated pneumonia in mechanically ventilated patients. Crit Care 12, P47 (2008). https://doi.org/10.1186/cc6268
- Mechanical Ventilation
- Respiratory Tract
- General Status
- Emergency Medicine