Comparative Study of Effect of Continuous versus Intermittent Subglottic Suctioning by the Suction Above the Cuff Endotracheal Tube (SACETT) on Tracheal Mucosa and Incidence of VAP in Intensive Care Unit

Abstract

Abstract Context Ventilator-associated pneumonia (VAP) is one of the important causes of morbidity and mortality in patients admitted to the intensive care unit (ICU) with ventilatory support. Subglottic secretion and their aspirations are primarily responsible for the occurrence of VAP and the risk of tracheal mucosa injury induced by subglottic suctioning and the risk of VAP inpatient on a ventilator has been raised. Aims Aim of this study is to compare the effect of continuous suctioning of subglottic secretions (CSSSs) versus intermittent suctioning of subglottic secretions (ISSS) on tracheal mucosa damage and incidence of VAP inpatient on a ventilator in both study groups. Settings and Design A prospective randomized study. Methods and Material A total of 140 patients requiring intubation or reintubation in the ICU with an expected ventilation duration > 24 hours were included in two groups: CSSS and ISSS. The effect on tracheal mucosa in front of the suction port was assessed after intubation (T0) and before extubation (T1) by bronchoscopy. VAP was compared in both groups on the basis of clinical suspicion and positive culture of bronchoalveolar lavage. Statistical Analysis Used The SAS statistical software version 9.4 (SAS Institute, Cary, North Carolina, United States) has been used for analysis. Chi-square of the Fisher's exact test and Student's t-test or the Wilcoxon rank-sum test were used for analysis. Results A total of 127 patients were included and 89 patients (CSSS, n = 44 and ISSS, n = 45) were evaluable on the primary endpoint. The occurrence or worsening of tracheal mucosal damages did not differ between the two groups (CSSS, n = 12 [27.3%] vs. ISSS, n = 8 [17.7%], p = 0.365). Daily average volume of suctioned secretion was higher with ISSS (72 ± 100 vs. 18 ± 25 mL, p < 0.001). Negligible chance to aspirate was higher with CSSS (0.13 ± 0.15 vs. 0.03 ± 0.06 per day, p < 0.001). Conclusion ISSS did not reduce mucosal damage as compared with CSSS. The aspirated volume was higher and the negligible chance to aspirate was lower with ISSS. The incidence of VAP was lower with CSSS.