Detection of pooled secretions above endotracheal-tube cuffs: value of plain radiographs in sheep cadavers and patients.

Greene, Reginald E.; Thompson, Shane A; Jantsch, H; Teplick, Richard; Cullen, David J.; Greene, Elizabeth M.; Whitman, Gary J.; Hulka, Carol A.; Llewellyn, Henry

doi:10.2214/ajr.163.6.7992723

Cited by 54 publications

(24 citation statements)

References 14 publications

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“…In addition, the presence of endotracheal tubes eliminates the cough reflex and contributes to the pooling of secretions above inflated endotracheal tube cuffs. Studies have shown that pooled secretions above inflated cuffs can predispose ventilated patients to VAP because of lower airway aspiration of these contaminated secretions (Greene et al, 1994;Oikkonen and Aromaa, 1997).…”

Section: Introductionmentioning

confidence: 99%

Effect of continuous oral suctioning on the development of ventilator-associated pneumonia: A pilot randomized controlled trial

Chow

Kwok

Luk

et al. 2012

International Journal of Nursing Studies

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Section: Introductionmentioning

confidence: 99%

Effect of continuous oral suctioning on the development of ventilator-associated pneumonia: A pilot randomized controlled trial

Chow

Kwok

Luk

et al. 2012

International Journal of Nursing Studies

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“…16,17 Similarly, our study found that it was less possible to clear secretions visibly if only a few secretions existed above the cuff. The subglottic secretions produced within 24 h were estimated to be 7.8 Ϯ 1.1 mL, according to Greene et al 18 ; thus, it is more reasonable to utilize the rapid flow expulsion maneuver intermittently (eg, every 6 -8 h). The actual frequency depends on the quantity of patients' oral secretions.…”

Section: Frequency Of the Maneuvermentioning

confidence: 99%

Evaluation of the Safety and Effectiveness of the Rapid Flow Expulsion Maneuver to Clear Subglottic Secretions in Vitro and in Vivo

Zong

Zhou

et al. 2017

Respir Care

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BACKGROUND: Clearing subglottic secretions has been proved to reduce ventilator-associated pneumonia. A manual method named the rapid flow expulsion maneuver was developed to clear subglottic secretions. This study evaluates its safety and effectiveness and analyzes the influential factors. METHODS: This study was composed of 2 parts. In an in vitro study, secretions were instilled directly to the area above the cuff in an intubated tracheal model. Secretions were expelled by the rapid flow expulsion maneuver with different volumes and peak flows in 3 tracheal positions (0, 15, and 30°). At each tracheal position, the maneuver was repeated twice, unless secretions above the cuff were <0.5 mL. In an in vivo study, subglottic secretions were suctioned via subglottic secretion drainage and then were cleared by the rapid flow expulsion maneuver. After the initial maneuver, methylene blue (2 mL) was instilled above the cuff, and the maneuver was performed again. The subject's sputum color was then recorded over 24 h. RESULTS: In the in vitro study, no aspiration was observed in the 277 maneuvers completed. Subglottic secretions were visibly expelled in 167 of 277 maneuvers (60.3%), and the median clearance efficiencies of the 3 consecutive maneuvers were 39.6, 6.3, and 0.4%. In the 108 first maneuvers, 93 (86.1%) produced visible secretions. Multiple linear regression models were used to identify predictors of clearance efficiency: tracheal position (P < .001), flow (P ‫؍‬ .041), and secretion viscosity (P ‫؍‬ .017). In the in vivo study, 77 rapid flow expulsion maneuvers were completed after suctioning via subglottic secretion drainage in 16 subjects, and the maneuvers collected 221.5 mL of secretions. No aspiration was observed over 24 h. CONCLUSIONS: The rapid flow expulsion maneuver was safe and effective to clear subglottic secretions. The first maneuver was the most effective to expel the majority of secretions. Supine position and high peak flow improved the clearance efficiency.

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“…Radiographic studies have revealed that secretions generally accumulate above the cuff of endotracheal tubes (in the subglottic region) before descending to the lower respiratory tract. 9 Because translocation of these secretions into the pulmonary parenchyma may lead to VAP, SSD has been used in clinical settings to combat VAP. However, SSD may also be associated with risks such as airway mucosal injury and bleeding, detection of which requires testing for occult blood.…”

Section: Zunjia Wen Is a Registered Nurse Haiying Zhang Is An Associmentioning

confidence: 99%

Continuous Versus Intermittent Subglottic Secretion Drainage to Prevent Ventilator-Associated Pneumonia: A Systematic Review

Wen¹,

Zhang²,

Ding³

et al. 2017

Crit Care Nurse

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Background Ventilator-associated pneumonia is associated with high morbidity and mortality in patients receiving mechanical ventilation. Subglottic secretion drainage, which may be performed continuously or intermittently, is believed to be an effective strategy for coping with ventilator-assisted pneumonia. Whether continuous or intermittent subglottic secretion drainage is superior for preventing ventilatorassisted pneumonia remains unknown. Methods This study is a comprehensive, systematic meta-analysis of randomized trials comparing continuous and intermittent subglottic secretion drainage in patients receiving mechanical ventilation. Studies in English and Chinese published from January 1970 through November 2015 were identified by searching multiple databases. Summary risk ratios or weighted mean differences with 95% CIs were used to calculate each outcome by means of fixed-or random-effects models. Results Eight studies enrolling a total of 1071 patients met the inclusion criteria. The summary risk ratio between continuous and intermittent subglottic secretion drainage for incidence of ventilator-assisted pneumonia was 0.83 (95% CI, 0.61-1.13); for time to ventilator-assisted pneumonia occurrence, 2.73 (95% CI, -0.39 to 5.85); for occult blood, 2.34 (95% CI, 0.25-21.88); for duration of mechanical ventilation, -0.89 (95% CI, -2.72 to 0.94); for length of intensive care unit stay, 3.98 (95% CI, -4.44 to 12.41); and for mortality, 0.80 (95% CI, 0.48-1.31). Conclusions The results indicate no apparent differences between continuous and intermittent subglottic secretion drainage for the treatment outcomes included in the analysis. Rigorously designed, large-scale randomized controlled trials are warranted to identify the roles of continuous and intermittent subglottic secretion drainage. (Critical Care Nurse. 2017;37[5]:e10-e17)

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Detection of pooled secretions above endotracheal-tube cuffs: value of plain radiographs in sheep cadavers and patients.

Abstract: OBJECTIVE

Cited by 54 publications

References 14 publications

Effect of continuous oral suctioning on the development of ventilator-associated pneumonia: A pilot randomized controlled trial

Effect of continuous oral suctioning on the development of ventilator-associated pneumonia: A pilot randomized controlled trial

Evaluation of the Safety and Effectiveness of the Rapid Flow Expulsion Maneuver to Clear Subglottic Secretions in Vitro and in Vivo

Continuous Versus Intermittent Subglottic Secretion Drainage to Prevent Ventilator-Associated Pneumonia: A Systematic Review

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