Efficacy of continuous versus intermittent subglottic secretion drainage in preventing ventilator-associated pneumonia in patients requiring mechanical ventilation: A single-center randomized controlled trial.

Hiroko Fujimoto,Mari Saito,Mika Shimosaka,Sayaka Tsuboi,Shigeo Takebayashi,Hajime Hayami,Satoshi Morita,Mitsunori Sato,Kiyoyasu Kurahashi,Takahisa Goto,Osamu Yamaguchi

doi:10.18632/oncotarget.24630

Abstract

ObjectiveAspiration of subglottic secretion is a widely used intervention to prevent ventilator-associated pneumonia (VAP). This study aimed to compare the efficacy of continuous and intermittent subglottic secretion drainage (SSD) in preventing VAP.MethodsA single-center randomized controlled trial was conducted on adult postoperative patients who were expected to undergo mechanical ventilation for more than 48 hours. Primary outcome measure was incidence of VAP and secondary outcome measures were length of mechanical ventilation and intensive-care unit (ICU) stay.ResultsFifty-nine patients received continuous SSD, while 60 patients received intermittent SSD. Of these 119 patients, 88 (74%) were excluded and 15 and 16 patients were allocated to receive continuous and intermittent SSD, respectively. VAP was detected in 4 (26.7%) and 7 (43.8%) patients in the continuous and intermittent groups, respectively, (p=0.320). The length of mechanical ventilation was significantly shorter (p=0.034) in the continuous group (99.5±47.1 h) than in the intermittent group (159.9±94.5 h). The length of ICU stay was also shorter (p=0.0097) in the continuous group (6.3±2.1 days) than the intermittent group (9.8±4.8 days).ConclusionsAlthough continuous SSD did not reduce the incidence of VAP, it reduced the length of mechanical ventilation and ICU stay when compared to intermittent SSD.

Highlights

Ventilator-associated pneumonia (VAP) is a common and serious complication of mechanical ventilation
Conclusions: continuous Subglottic secretion drainage (SSD) did not reduce the incidence of VAP, it reduced the length of mechanical ventilation and intensive-care unit (ICU) stay when compared to intermittent SSD
Many studies have shown that the accumulation of subglottic secretions above the endotracheal cuff plays an important role in the pathogenesis of VAP [1, 2, 7]

Summary

Introduction

Ventilator-associated pneumonia (VAP) is a common and serious complication of mechanical ventilation. Many studies have shown that the accumulation of subglottic secretions above the endotracheal cuff plays an important role in the pathogenesis of VAP [1, 2, 7]. Subglottic secretion drainage (SSD) has been shown to be associated with a lower incidence of VAP in previous meta-analyses [17,18,19]. In a study by Wang et al [17], both continuous and intermittent SSD reduced the incidence of VAP. Continuous SSD is considered to be superior to intermittent SSD in terms of reducing the incidence of influx of subglottic secretion into the trachea. Continuous SSD has a risk to cause a herniation of tracheal mucosa into the subglottic suction port, and may lead to either mucosal injury [20] or aspiration insufficiency [21]

Methods

Results

Conclusion