Prevention of Ventilator-Associated Pneumonia Through Aspiration of Subglottic Secretions

Leasure, A. Renee; Stirlen, Joan; Lu, Shu Hua

doi:10.1097/dcc.0b013e3182445ff3

Cited by 26 publications

(25 citation statements)

References 31 publications

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“…11,22 Among our sample, 6 patients with aspiration were intubated with a subglottic suction endotracheal tube, which is thought to reduce microaspiration. 23,24 However, 3 of the 4 patients with a traditional endotracheal tube had documented aspiration.…”

Section: Discussionmentioning

confidence: 99%

Pepsin and Amylase in Oral and Tracheal Secretions: A Pilot Study

Sole¹,

Conrad²,

Bennett³

et al. 2014

American Journal of Critical Care

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worth, RN, MSN, CCRN, CCNS, and Devendra Indulal Mehta, MBBS, MSc(dist), MRCP Background Endotracheal intubation increases the risk for microaspiration of secretions around the tube cuff. Pepsin has been used as a biomarker for gastric aspiration. Amylase is a newer proposed biomarker for aspiration of oral contents. Objective To assess the presence of pepsin and amylase in paired oral-tracheal secretions of adult patients treated with mechanical ventilation. Methods In this descriptive study, paired samples of oral and tracheal secretions were obtained from adult patients at baseline and again within 4 hours when a need for endotracheal suctioning was assessed. Assays of pepsin and amylase were processed in a specialty diagnostic laboratory. Results The sample consisted of 10 men and 3 women with a median age of 56 years. The majority were intubated with a subglottic suction endotracheal tube (9 patients, 69%), receiving synchronized intermittent mandatory ventilation (10 patients; 77%), and receiving enteral feedings (11 patients; 85%) through a tube distally placed in the stomach (8 patients; 67%). Pepsin was present in oral secretions of 9 patients (69%), and in tracheal specimens of 7 patients (54%) at one or both sampling times. Amylase was detected in all patients' oral secretions and in tracheal secretions of 5 patients (38%) at one or both sampling times. Conclusions Many patients had pepsin, amylase, or both in tracheal aspirates. Pepsin was more commonly detected than was amylase. Although the relationship of this finding to longterm outcomes was not assessed, findings indicate that microaspiration of oral and gastric secretions occurs frequently.

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Section: Discussionmentioning

confidence: 99%

Pepsin and Amylase in Oral and Tracheal Secretions: A Pilot Study

Sole¹,

Conrad²,

Bennett³

et al. 2014

American Journal of Critical Care

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“…When only including studies that enrolled subjects expected to require (Table 2). [139][140][141][142] Regardless of the combination of the studies included in the analysis, the results suggest that SSD results in a reduction of VAP by ϳ50% and may be associated with reduced early onset of VAP, shorter duration of mechanical ventilation, and fewer days in the ICU, but not a reduced mortality.…”

Section: Subglottic Secretion Drainagementioning

confidence: 91%

Endotracheal Tubes: Old and NewDiscussion

et al. 2014

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The development and evolution of the endotracheal tube (ETT) have been closely related to advances in surgery and anesthesia. Modifications were made to accomplish many tasks, including minimizing gross aspiration, isolating a lung, providing a clear facial surgical field during general anesthesia, monitoring laryngeal nerve damage during surgery, preventing airway fires during laser surgery, and administering medications. In critical care management, ventilator-associated pneumonia (VAP) is a major concern, as it is associated with increased morbidity, mortality, and cost. It is increasingly appreciated that the ETT itself is a primary causative risk for developing VAP. Unfortunately, contaminated oral and gastric secretions leak down past the inflated ETT cuff into the lung. Bacteria can also grow within the ETT in biofilm and re-enter the lung. Modifications to the ETT that attempt to prevent bacteria from entering around the ETT include maintaining an adequate cuff pressure against the tracheal wall, changing the material and shape of the cuff, and aspirating the secretions that sit above the cuff. Attempts to reduce bacterial entry through the tube include antimicrobial coating of the ETT and mechanically scraping the biofilm from within the ETT. Studies evaluating the effectiveness of these modifications and techniques demonstrate mixed results, and clear recommendations for which modification should be implemented are weak.

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“…However, SSD may also be associated with risks such as airway mucosal injury and bleeding, detection of which requires testing for occult blood. 10 Although the efficacy of SSD was in question in past decades, previous meta-analyses have consistently concluded that SSD reduces the rate of early-onset VAP, [11][12][13][14][15] and the use of SSD for VAP prophylaxis is highly recommended by guidelines and experts. 16,17 SSD may be performed as continuous SSD (CSSD) or intermittent SSD (ISSD).…”

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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Prevention of Ventilator-Associated Pneumonia Through Aspiration of Subglottic Secretions

Cited by 26 publications

References 31 publications

Pepsin and Amylase in Oral and Tracheal Secretions: A Pilot Study

Pepsin and Amylase in Oral and Tracheal Secretions: A Pilot Study

Endotracheal Tubes: Old and NewDiscussion

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

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