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Abstract

Introduction: Ventilator-associated pneumonia (VAP) is a significant problem in trauma patients. Studies in other patient populations have shown considerable reductions in VAP with the use of endotracheal tubes (ETT) allowing subglottic secretion drainage (SSD). However, there have been no studies focusing on critically-ill trauma patients. Hypothesis: Intermittent aspiration of subglottic secretions will reduce the incidence of VAP in critically-ill trauma patients requiring mechanical ventilation. Methods: Prospective study of 104 consecutive adult patients admitted to a Level I trauma center, intubated with a tracheal tube allowing SSD, who required mechanical ventilation for > 48 hours. A comparison group of 116 adult patients identified from the trauma registry, intubated with a standard ETT, was used. Primary outcome was the incidence of VAP. Secondary endpoints included ventilator days (VENT), ICU days and mortality. VAP was defined by CDC criteria. Results: Patients were severely injured with a mean ISS of 27. The groups did not differ with respect to age, blunt versus penetrating mechanism of injury, AIS - head or chest, or ISS. VAP incidence between the two groups was clinically but not statistically significant (8.6 % SSD vs. 15.5 % ETT, p = 0.16). However, days to VAP (SSD 12.2 + 3 vs. ETT 14.5 + 12), VENT days (SSD 13 ± 11 vs. ETT 15 ± 12, p = 0.4), ICU days (SSD 16 ± 13 vs. ETT 17 ± 13, p = 0.57), and mortality (SSD 20% vs. ETT 22%, p = 0.80) did not differ between the groups. Need for tracheostomy was also equivalent between the groups. Conclusions: In severely injured trauma patients requiring prolonged mechanical ventilation, the use of endotracheal tubes allowing subglottic secretion drainage does not reduce the incidence of ventilator-associated pneumonia.