Abstract
BackgroundContinuous aspiration of subglottic secretions is effective in preventing ventilator-associated pneumonia, but it involves a risk of mucosal damage. The main objective of our study was to determine the incidence of airway complications related to continuous aspiration of subglottic secretions.MethodsIn consecutive adult patients with continuous aspiration of subglottic secretions, we prospectively recorded clinical airway complications during the period after extubation. A multidetector computed tomography of the neck was performed during the period of 5 days following extubation to classify subglottic and tracheal lesions as mucosal thickening, cartilage thickening or deep ulceration.ResultsIn the 86 patients included in the study, 6 (6.9%) had transient dyspnea, 7 (8.1%) had upper airway obstruction and 18 (20.9%) had dysphonia at extubation. Univariate analysis identified more attempts required for intubation (2.3 ± 1.1 vs. 1.2 ± 0.5; p = 0.001), difficult intubation (71.4 vs. 10.1%, p = 0.001) and Cormack score III–IV (71.4 vs. 8.8%; p < 0.001) as risk factors for having an upper airway obstruction at extubation. The incidence of failed extubation among patients after planned extubation was 18.9% and 11 patients (12.7%) required tracheostomy. A multidetector computed tomography was performed in 37 patients following extubation, and injuries were observed in 9 patients (24.3%) and classified as tracheal injuries in 2 patients (1 cartilage thickening and 1 mild stenosis with cartilage thickening) and as subglottic mucosal thickenings in 7 patients.ConclusionsThe incidence of upper airway obstruction after extubation in patients with continuous aspiration of subglottic secretions was 8.1%, and the injuries observed by computed tomography were not severe and located mostly in subglottic space.
Highlights
Continuous aspiration of subglottic secretions is effective in preventing ventilator-associated pneu‐ monia, but it involves a risk of mucosal damage
Continuous aspiration of subglottic secretions (CASS) is effective in preventing ventilator-associated pneumonia (VAP), it involves a risk of mucosal damage secondary to aspiration because the external diameter is higher than conventional tubes
We excluded patients transferred from hospitals who were intubated with endotracheal tubes without accessory channel that allows subglottic aspiration, those with a history of tracheostomy or tracheal lesions, those intubated > 48 h in the 30 days prior to the current admission and those enrolled in other trials
Summary
Continuous aspiration of subglottic secretions is effective in preventing ventilator-associated pneu‐ monia, but it involves a risk of mucosal damage. The main objective of our study was to determine the incidence of airway complications related to continuous aspiration of subglottic secretions. VAP is mainly due to the use of an artificial airway and repeated microaspirations of secretions from the oropharynx containing microorganisms through the space between the endotracheal tube and the tracheal wall. One recommended non-pharmacological measure reduces microaspirations by using an endotracheal tube with an accessory channel that allows subglottic secretions accumulated above the endotracheal cuff to be removed. These tubes allow secretions to be aspirated intermittently or continuously [6,7,8]
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