Chest
Clinical Investigations in Critical CareA Randomized Clinical Trial of Intermittent Subglottic Secretion Drainage 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.
References (32)
- et al.
The effect of late-onset ventilator-associated pneumonia in determining patient mortality
Chest
(1995) - et al.
Epidemiology of nosocomial pneumonia: new perspectives on an old disease
Chest
(1995) - et al.
A randomized clinical trial of continuous aspiration of subglottic secretions in cardiac surgery patients
Chest
(1999) - et al.
A predictive risk index for nosocomial pneumonia in the intensive care unit
Am J Med
(1992) - et al.
Aspiration of gastric bacteria in antacid-treated patients: a frequent cause of postoperative colonization of the airway
Lancet
(1982) - et al.
Penetration of an aerosol, produced by film atomization, through the carnial bifurcation
Br J Anaesth
(1993) Cost of nosocomial infections and benefits of infection control programs
- et al.
Risk factors for nosocomial infection
J infect Dis
(1978) Hospital-acquired pneumonia
- et al.
Pneumonia in an intensive care unit
Ann Intern Med
(1974)
Nosocomial infections in a newborn intensive care unit
N Engl J Med
Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay
Am J Med
Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation
Am Rev Respir Dis
Incidence, risk and prognosis factors of nosocomial pneumonia in ventilated patients
Am Rev Respir Dis
Ventilator-associated pneumonia due toPseudomonas aeruginosa
Chest
Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia
Ann Intern Med
Cited by (221)
Comparison of subglottic vs. non-subglottic secretion drainage in prevention of Ventilator Associated Pneumonia: A systematic review and meta-analysis
2022, Trends in Anaesthesia and Critical CareEvaluation of pH on removed tracheal tubes after general anesthesia: a prospective observational study
2016, Journal of Clinical AnesthesiaThe Coming of Age of Implementation Science and Research in Critical Care Medicine
2021, Critical Care MedicineAnesthesia for peroral endoscopic myotomy (POEM)
2021, Anaesthesia for Uncommon and Emerging ProceduresPseudomonas aeruginosa bioflm formation on endotracheal tubes requires multiple two-component systems
2020, Journal of Medical Microbiology