Effect of Endotracheal Tube with Subglottic Suction Port vs Standard Endotracheal Tube on Incidence of Ventilator Associated Pneumonia in Patients of Organo-Phosphate Poisoning

Abstract

Ventilator associated pneumonia is a hospital acquired infection that develops after 48 hours or more after a patient is intubated with an endotracheal or tracheostomy tube and is put on mechanical ventilation [1]. Ventilator associated pneumonia is most common nosocomial infection in ICU and associated with prolonged hospitalization, increased health care costs, and high attributable mortality. Intubation independently increases the risk of developing nosocomial pneumonia atleast seven fold with a peak incidence occurring around day five of ventilation [2]. Tracheal intubation thwarts cough reflex, compromises mucociliary clearance, injures tracheal epithelial surface, provides a direct conduct for rapid access of bacteria from upper into lower respiratory tract and allows formation of biofilm on Endotracheal tube surface. The combination of these factors puts mechanically ventilated patient at great risk of developing VAP. Aims and Objectives: To study incidence of VAP in ET tube with subglottic suction port versus standard ET tube in cases of O.P poisoning in J.J.M Medical college, Davangere from December 2015-June 2017. Material and Methods: A prospective observational case control study of 80 patients admitted to Red Zone/ICU of J.J.M. Medical College, Davangere. Results: Patients who have presented with Organophosphorous poisoning between the age group of 18 to 60 years who require ventilator support, intubated with standard ET tube and another sub set of patients intubated with ET tube with subglottic suction port were analysed. In this study we found that distribution of various organisms with regards to sputum culture in both groups were pseudomonas being maximum and proteus was found in minimum percentage. When subglottic suction port is used we observed improved patients were 70% and deaths were 30%. When subglottic suction port is not used we observed improved were 55% and death were 45%. Conclusion: VAP is common in patients who are intubated in ICU, which has higher morbidity and mortality among these patients. In our study we observed that atropine usually decreases secretions, but here in this study patient population who were admitted developed secretions instead of adequate atropine dosage and also developed VAP. Use of ET tube with Subglottic suction drainage may prevent VAP in cases of Organo Phosphorous poisoning and also improves patient outcomes.