Chest
Volume 121, Issue 3, March 2002, Pages 858-862
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Clinical Investigations in Critical Care
A Randomized Clinical Trial of Intermittent Subglottic Secretion Drainage in Patients Receiving Mechanical Ventilation

https://doi.org/10.1378/chest.121.3.858Get rights and content

Objective

To study the effect of subglottic secretions drainage on the incidence of ventilator-associated pneumonia (VAP) in patients receiving mechanical ventilation.

Setting

A 12-bed general ICU.

Patients

One hundred fifty patients with an expected duration of mechanical ventilation > 72 h were enrolled in the study.

Intervention

Patients were randomly assigned to receive either an endotracheal tube for intermittent subglottic secretions drainage or a standard endotracheal tube.

Outcome measurements

Incidence of VAP, duration of mechanical ventilation, length of ICU stay, length of hospital stay, and mortality.

Results

Seventy-five patients were randomized to subglottic secretion drainage, and 75 patients were randomized to the control group. The two groups were similar at the time of randomization with respect to demographic characteristics and severity of illness. VAP was seen in 3 patients (4%) receiving suction secretion drainage and in 12 patients (16%) in the control group (relative risk, 0.22; 95% confidence interval, 0.06 to 0.81; p = 0.014). The other outcome measures were not significantly different between the two groups.

Conclusion

Intermittent subglottic secretion drainage reduces the incidence of VAP in patients receiving mechanical ventilation.

Section snippets

Study Protocol

The study was performed in a 12-bed general ICU at the Bosch Medical Center, ‘s-Hertogenbosch, the Netherlands. The study protocol was reviewed and approved by the medical ethical committee of the hospital. Between May 1999 and June 2000, we studied 150 patients admitted to our ICU and expected to receive mechanical ventilation for > 72 h. Randomization was performed by drawing a card from a sealed envelope. The study group received an oral endotracheal tube with the possibility of intermittent

Total Study Population

Over a period of 13 months, 150 patients were enrolled in the study. The demographic data of the total study population are shown in Table 1. The two groups were similar in age, demographic characteristics, severity of illness on hospital admission, and underlying diseases. Fifteen patients (10%) had VAP develop, yielding a rate of 15.6 episodes of VAP per 1,000 ventilator-days. Three patients (4%) in the study group and 12 patients (16%) in the control group had VAP develop (RR, 0.22; 95% CI,

Discussion

In this randomized trial, 150 patients with an expected duration of mechanical ventilation > 72 h were randomized to intermittent subglottic secretion drainage or to a control group. VAP developed in 15 patients (10%), which translates to an incidence rate of 15.6 episodes per 1,000 ventilator-days. Patients randomized to intermittent subglottic secretion drainage had a statistically lower incidence of VAP than patients intubated with the conventional endotracheal tube. Three patients had VAP

ACKNOWLEDGMENT

The authors thank the nursing staff of the ICU, the anesthesiologists, and the staff of the Department of Medical Microbiology of Bosch Medicentrum for their assistance.

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