Subglottic Drainage Decreases Risk of Ventilator-Associated Pneumonia

A new study has found that in patients on mechanical ventilation, intermittent subglottic secretions drainage (SSD) leads to a significant reduction in ventilator-associated pneumonia (VAP).

Researchers at André Mignot Hospital (Le Chesnay, France) and CHI Poissy Saint-Germain Hospital (Poissy, France) conducted a randomized controlled clinical trial at four French centers to determine whether SSD reduces the overall incidence of microbiologically confirmed VAP. A total of 333 adult patients intubated with a tracheal tube allowing drainage of subglottic secretions were randomly assigned to undergo intermittent SSD (169 patients) or not (164 patients). The primary outcome measure was the overall incidence of VAP, based on quantitative culture of distal pulmonary samplings performed after each clinical suspicion. Other outcomes included incidence of early- and late-onset VAP, duration of mechanical ventilation, and intensive care unit (ICU) mortality.

The results showed that microbiologically confirmed VAP was seen in 14.8% of the drainage group, compared to 25.2% of control patients. During the first 5 days, rates of pneumonia were 1.2% and 6.1%, respectively; for later onset, the corresponding rates were 18.6% and 33.0%.

There were no between-group differences in the duration of mechanical ventilation; this was also true of in-hospital ICU mortality (47.3% vs. 51.2%). The study was published ahead of print on June 3, 2010, in the American Journal of Respiratory Critical Care Medicine.

"Subglottic secretions drainage during mechanical ventilation results in a significant reduction in VAP, including late-onset VAP,” concluded lead author Jean-Claude Lacherade, M.D., of CHI Poissy Saint-Germain, and colleagues. "This should prompt physicians involved in pre-ICU care to use endotracheal tubes permitting secretion drainage.”

VAP is a costly complication of hospitalization that lengthens ICU and hospital stay, and increasing morbidity and mortality. Among evidence-based measures to prevent VAP is the use of a specialized endotracheal tube that aspirates subglottic secretions, and recommendations for SDD are found in guidelines published by the U.S. Centers for Disease Control and Prevention (CDC; Atlanta, GA, USA) and the American Thoracic Society (ATS), among others.

Related Links:
André Mignot Hospital
CHI Poissy Saint-Germain Hospital
U.S. Centers for Disease Control and Prevention