Investigating the Role of Subglottic Secretions Suctioning in the Prevention of ‎Ventilator Associated Pneumonia in Patients With Invasive Mechanical ‎Ventilation

Abstract

BACKGROUND: development of ventilator associated pneumonia (VAP) leads to ‎prolonged hospital stay, increased health care cost, and mortality rates. Subglottic ‎secretion drainage through a dedicated endotracheal tube has been advocated as a mean ‎to decrease the incidence of VAP and thereby assisting in ‎the decrease of morbidity associated with invasive mechanical ventilation.‎
 
 OBJECTIVE: Investigate the role of subglottic secretion suctioning in the prevention of VAP in mechanically ventilated patients in intensive care unit.‎
 
 METHODS: A cross sectional study done in the intensive care unit of Ghazi Al-Hariri ‎hospital for surgical specialties in medical city complex, 30 patients who ‎are in need for invasive mechanical ventilation were intubated with endotracheal tube ‎that have special port for subglottic secretion suctioning. Daily monitoring of patients ‎clinical and radiological data to detect features of VAP was ‎done, and if there was a suspicion of pneumonia, culture for tracheal aspirate performed ‎to confirm diagnosis.‎
 
 RESULTS: ‎Patient’s age was 37.1 ± ‎‎15.39 years, the highest proportion of study patients was found in ‎age group < 30 and ‎‎30–49 years (40% in ‎each group), most of the patients were males (70%) with a male to female ratio of ‎‎2.33:1‎‏, ‏Subglottic secretion suctioning lead to reduction in VAP by relative risk (95%CI) of ‏‎0.167 (0.045–0.559)‎‏, p-‏value = 0.001. ‏Twenty eight patients didn’t show any sign, symptoms ‎or radiological features suggesting a ‎diagnosis of pneumonia while two patients developed ‎features of pneumonia (suggestive signs and ‎symptoms, radiological features and ‎positive culture of tracheal aspirate).‎
 
 CONCLUSION: the use of endotracheal tube with subglottic ‎secretions suctioning can have a role in the prevention of VAP in mechanically ventilated patients.‎

Prevention of VAP: Endless evolving evidences–systematic literature review

“…The drainage of secretions collected above the cuff of the endotracheal tube has significant reduction in incidence of VAP 21 . Patients expected to require mechanical ventilation for more than 48 h are candidates for drainage of subglottic secretions.…”