Would “suction above cuff” be a better option than the “standard” endotracheal tube for the prevention of ventilator-associated pneumonia: A randomized study in postoperative neurological patients

Gunjan,; Ankesh,; Shekhar, Saurav; Akhileshwar, .; Kumar, Priyesh

doi:10.4103/aer.aer_39_18

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…These results were corroborated by a further RCT which linked subglottic secretions suctioning to a significant reduction in VAP prevalence and in antibiotic consumption [52]. Several further studies and a very recent meta-analysis led to similar results [53][54][55][56]; however, some failed to show a decrease in clinical and microbiological VAP incidence, maybe due to small sample sizes [57][58][59]. Some authors have also questioned what the proper modality should be, even in terms of timing or system design.…”

Section: Other Nonpharmacological Interventionsmentioning

confidence: 91%

Pathogenesis-Targeted Preventive Strategies for Multidrug Resistant Ventilator-Associated Pneumonia: A Narrative Review

et al. 2020

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Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection in the intensive care unit (ICU), accounting for relevant morbidity and mortality among critically ill patients, especially when caused by multidrug resistant (MDR) organisms. The rising problem of MDR etiologies, which has led to a reduction in treatment options, have increased clinician’s attention to the employment of effective prevention strategies. In this narrative review we summarized the evidence resulting from 27 original articles that were identified through a systematic database search of the last 15 years, focusing on several pathogenesis-targeted strategies which could help preventing MDR-VAP. Oral hygiene with Chlorhexidine (CHX), CHX body washing, selective oral decontamination (SOD) and/or digestive decontamination (SDD), multiple decontamination regimens, probiotics, subglottic secretions drainage (SSD), special cuff material and shape, silver-coated endotracheal tubes (ETTs), universal use of gloves and contact isolation, alcohol-based hand gel, vaporized hydrogen peroxide, and bundles of care have been addressed. The most convincing evidence came from interventions directly addressed against the key factors of MDR-VAP pathogenesis, especially when they are jointly implemented into bundles. Further research, however, is warranted to identify the most effective combination.

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Section: Other Nonpharmacological Interventionsmentioning

confidence: 91%

Pathogenesis-Targeted Preventive Strategies for Multidrug Resistant Ventilator-Associated Pneumonia: A Narrative Review

et al. 2020

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“…[22][23][24] Other small studies have failed to show a reduction in VAP incidence with subglottic secretion drainage, possibly due to insufficient statistical power. [25][26][27] A meta-analysis confirmed the association between the use of a subglottic secretion drainage system and reduced VAP occurrence; the effect may be mediated by lower incidence of Gram-positive VAP. 28,29 A small clinical study reported that continuous subglottic aspiration may carry a possible advantage over intermittent aspiration.…”

Section: Subglottic Secretion Drainage Systemmentioning

confidence: 97%

Non-Pharmacological Interventions to Prevent Ventilator-Associated Pneumonia: A Literature Review

Coppadoro

Bellani

2019

Respir Care

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Ventilator-associated pneumonia (VAP) is a well-known complication of invasive mechanical ventilation in critically ill patients. The presence of an endotracheal tube (ETT) is one of the major culprits for VAP development: air flow moves pathogens toward the distal airways, while clearance of the trachea is blunted due to reduced tracheal ciliary movement and impaired cough. Several measures are recognized as being useful to prevent VAP, and these are usually grouped in a VAP bundle (ie, avoiding intubation or re-intubation whenever possible; head of bed elevation; hand hygiene; shortening ventilation through sedation interruptions, spontaneous breathing trials, or thromboembolic prophylaxis). However, other interventions have been proposed to reduce VAP rate; some of these interventions have been reported in large clinical trials to be effective, some have been evaluated in small observational studies, and still others at a pre-clinical stage. Some strategies aim to improve the ETT design via a subglottic drainage system, with treatment of the ETT surface to reduce pathogen activity, or by modification of the cuff shape or cuff material to provide a better seal. Another proposed strategy is improving airway care through control of cuff pressure, cleaning the ETT, or use of closed suction systems. Other interventions target a patient's position in the bed to reduce aspiration of digestive content in the airways, or the use of probiotics to modulate gastric flora. Some of these measures are supported by strong evidence, but the impact on relevant outcomes such as duration of ventilation or mortality, as well as cost-benefit ratio, is still unclear, resulting in lack of widespread use.

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“…The Suction above Cuff Endotracheal Tube (SACETT) has a dorsal port above the cuff designed to enable suctioning of secretions from the subglottic space. Because the SACETT facilitates the suctioning of excessive secretions in the subglottic area, is preferred in intensive care units 5,6. However, the use of the SACETT in in rhinoplasty operations has not been adequately investigated.…”

Section: Introductionmentioning

confidence: 99%

<p>Effect of using the Suction Above Cuff Endotracheal Tube (SACETT) on postoperative respiratory complications in rhinoplasty: a randomized prospective controlled trial</p>

Yüzkat¹,

Demir²

2019

TCRM

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Background: The Suction Above Cuff Endotracheal Tube (SACETT) has a dorsal port above the cuff designed to enable the continuous or intermittent suctioning of secretions from the subglottic space. Thus, it facilitates the suctioning of excessive secretions above the cuff and around the glottis. Objectives: In this study, we investigated the effect of the using the SACETT on laryngospasm and postoperative complications in rhinoplasty operations. Methods: This randomized controlled clinical trial enrolled 132 patients undergoing rhinoplasty. The patients were randomly divided into two groups: Suction above Cuff Endotracheal Tube ( n =66; Group SA) and classic endotracheal tube ( n =66; Group C). Complications following general anesthesia were statistically analyzed among the two groups. Results: The incidence of postoperative laryngospasm ( p =0.02) and respiratory complications was found to be lower in Group SA than in Group C. In addition, the incidence of agitation ( p =0.035), postoperative nausea, and vomiting (PONV) ( p =0.041), which required antiemetic drug administration, swallowing difficulty ( p =0.012), and sore throat ( p =0.027) were found to be lower in Group SA than in Group C. Conclusion: We suggest that using the SACETT in rhinoplasty reduces the incidence of postoperative respiratory complications as well as the incidence of agitation, sore throat, swallowing difficulty, and PONV. Clinical Trial Number: NCT03584503

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Would “suction above cuff” be a better option than the “standard” endotracheal tube for the prevention of ventilator-associated pneumonia: A randomized study in postoperative neurological patients

Cited by 3 publications

References 12 publications

Pathogenesis-Targeted Preventive Strategies for Multidrug Resistant Ventilator-Associated Pneumonia: A Narrative Review

Pathogenesis-Targeted Preventive Strategies for Multidrug Resistant Ventilator-Associated Pneumonia: A Narrative Review

Non-Pharmacological Interventions to Prevent Ventilator-Associated Pneumonia: A Literature Review

<p>Effect of using the Suction Above Cuff Endotracheal Tube (SACETT) on postoperative respiratory complications in rhinoplasty: a randomized prospective controlled trial</p>

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