Subglottic Secretion Research Articles

Cuidados preventivos para pneumonia associada a ventilação mecânica: revisão integrativa

Introdução: A pneumonia associada a ventilação mecânica é a segunda causa de infecção em pacientes de unidade de terapia intensiva causando altas taxas de mortalidade e de custos hospitalares. O objetivo deste estudo foi identificar na literatura os cuidados mais importantes para prevenir pneumonia associada a ventilação mecânica. Metodologia: Trata-se de estudo exploratório em fontes secundárias, com abordagem qualitativa e utilização do método de revisão integrativa. Resultados: Obteve-se amostragem de 18 artigos publicados, os cuidados considerados mais importantes para prevenção de pneumonia associada a ventilação mecânica adotados pelos profissionais de saúde foram: higiene oral (94,4%), elevação da cabeceira no leito 30º- 45º (77,7%), pressão do cuff (66,6%), aspiração de secreção subglótica (55,5%), manutenção do circuito do ventilador (38,85) e higienização das mãos (33,3%). Conclusão: O estudo mostra a importância da aplicação destes cuidados para redução na taxa de incidência de pneumonia associada a ventilação mecânica, no tempo de uso do ventilador mecânico e de permanência na unidade de terapia intensiva. E revela que o cuidado menos realizado pelos profissionais é a higienização das mãos considerado um cuidado simples, prático e eficaz para a prevenção de infecções hospitalares.
 

Subglottic secretion drainage for preventing ventilator-associated pneumonia: an overview of systematic reviews and an updated meta-analysis.

Although several guidelines recommend subglottic secretion drainage as a strategy for prevention of ventilator-associated pneumonia (VAP), its use is not widespread. With the aim to assess the effectiveness of subglottic secretion drainage for preventing VAP and to improve other outcomes such as mortality, duration of mechanical ventilation and length of stay in the intensive care unit (ICU) or hospital, an electronic search of the Cochrane Library, MEDLINE, Web of Science and Embase was undertaken. Nine systematic reviews with meta-analysis (in the overview of reviews) and 20 randomised controlled trials (in the updated meta-analysis) were included.In the overview of reviews, all systematic reviews with meta-analysis included found a positive effect of subglottic secretion drainage in the reduction of incidence of VAP. In the updated meta-analysis, subglottic secretion drainage significantly reduced VAP incidence (risk ratio (RR) 0.56, 95% CI 0.48-0.63; I2=0%, p=0.841) and mortality (RR 0.88, 95% CI 0.80-0.97; I2=0%, p=0.888).This is the first study that has found a decrease of mortality associated with the use of subglottic secretion drainage. In addition, subglottic secretion drainage is an effective measure to reduce VAP incidence, despite not improving the duration of mechanical ventilation and ICU and/or hospital length of stay.

Active surveillance of ventilator-associated pneumonia in the intensive care unit and establishment of the risk grading system and effect evaluation.

To discuss ventilator-associated pneumonia (VAP) patient's clinical characteristic and related factors in the intensive care unit (ICU), and to establish a risk grading system for VAP patients in the ICU in order to provide a reference for VAP prevention. A total of 1,513 patients in eight ICUs who received mechanical ventilation between June 2015 and June 2018 were randomized and into two groups, with 908 patients in the model group and 605 patients in the verification group. The model group was used to analyze the influencing factors of VAP and establish a risk grading system, while the verification group was used to verify the risk grading system. A receiver operating characteristic (ROC) curve was used to evaluate the predictive effect of the grading system. During the 3-year study period, of the 1,513 total patients, 188 patients were infected with VAP, leading to an incidence rate of 12.43% (188/1,513) and an infection rate of 15.23‰ (188/12,347). ICU length of stay, mechanical ventilation days, frequency of oral care, unused subglottic secretion drainage, tracheotomy, APACHE II score, and combined antibiotics use were risk factors of VAP infection for patients who received mechanical ventilation in the modeling group (P<0.05). In a VAP risk-grading system established based on risk factors, the high, medium and low-grade patients had a statistically significantly different VAP infection rate in the model group, and patients with a high grade had a higher risk of VAP infection. Patients' data in the model and verification groups were used to draw a ROC curve which showed a good predictive effect. This study establishes and verifies the VAP risk grading system for patients who receive mechanical ventilation. It is helpful in high-risk patient surveillance and in reducing and preventing VAP infection.

Application and promotion of continuous aspiration of subglottic secretionby stabilized pressure suction technique

Objective Through the popularization of the technique of stabilized pressure of the subglottic secretion, to improve the drainage effect of subglottic secretion of intensive care unit (ICU) patients in this region, and to improve the quality of subglottic secretion management. Methods The stabilized pressure device on continuous aspiration of subglottic secretion was designed and the pressure-stabilized technique for subglotted secretion was promoted in 7 hospitals in Zhejiang province from January to December of 2018. The quality of drainage of subglottic secretion before and after the promotion of the stabilized technique were compared. In every hospital the included research objects were divided into two groups, and the subglottic secretion stabilized pressure devices adopted two suctioning methods of intermittent and continuous accordingly in the two groups: intermittent group (n=161) and continuous group (n=160) , the incidence of blockage of decompression holes and instability of negative pressure control were compared between the two groups, and the incidences of drainage, cough, blockage of tube and mucosal injury during were compared. Results After promotion, the quality of subglotted secretion suctioning in 7 hospitals all improved, among which the dimensions of suction operation and outcome indicator showed statistically significant difference before and after promotion (P<0.05) . In terms of the performance of stabilized pressure device, the blockage rate of decompression holes in continuous group (3.13%) was higher than that in intermittent group, and the incidence of negative pressure control instability (3.75%) was lower than that in intermittent group; in terms of the effect of subglottic drainage, the drainage flow rate of subglottic secretion in continuous group was (53.55±5.92) ml/d, and the daily coughing times were (3.01±1.13) , both better than the intermittent group, the difference was statistically significant (t=12.374, -2.625; P< 0.05) . Conclusions Subglottic secretion pressure-stabilized device has good performance, and the technology of pressure-stabilized can effectively improve drainage effect. The method of continuous is recommended in this study, which has a significant effect on improving the drainage quality of subglottic secretion and has a good promotion effect. Key words: Intensive care unit; Subglottic secretion; Suction technique; Technique promotion

Prevention of Intensive Care Unit-Acquired Pneumonia.

Intensive care unit (ICU) acquired pneumonia is one of the most common and morbid health care-associated infections. Despite decades of work developing and testing prevention strategies, ICU-acquired pneumonia remains stubbornly pervasive. Pneumonia prevention studies are difficult to interpret because all are at risk of bias due to the subjectivity and poor specificity of pneumonia definitions. Interventions associated with improvements in objective outcomes in addition to pneumonia, such as length of stay or mortality, should therefore be prioritized. Avoiding intubation, minimizing sedation, implementing early extubation strategies, and mobilizing patients do appear to improve some of these objective outcomes. Many of our other assumptions about how best to prevent ICU-acquired pneumonia, however, have recently been challenged. Elevating the head of the bed is supported by very little randomized trial data. Early reports suggested that subglottic secretion drainage may decrease time to extubation and ICU length of stay, but more recent analyses refute these findings. Novel endotracheal tube cuff designs do not clearly lower pneumonia rates. A large randomized trial of selective digestive decontamination in ICUs with high baseline rates of antimicrobial resistance did not identify any benefit. Oral care with chlorhexidine may increase mortality risk and stress ulcer prophylaxis may facilitate pneumonia. Early data on probiotics suggest a possible effect but there is no clear signal yet that they shorten duration of mechanical ventilation or lower mortality. Ventilator bundles on balance do appear to be beneficial but it is not clear which components are most important nor how best to implement them. This article will review recent studies that have challenged, refined, or complicated our understanding of how best to prevent ICU-acquired pneumonia.

Airway Management and Ventilator-Associated Events.

Airway management techniques are aimed at reducing complications associated with artificial airways and mechanical ventilation, such as retained secretions. The impact of airway management techniques on ventilator-associated events (VAEs) varies considerably by modality. Closed-suction techniques are generally recommended but have limited, if any, impact on VAEs. Normal saline instillation during suctioning is not recommended. Devices designed specifically to remove biofilm from the inside of endotracheal tubes appear to be safe, but their role in VAE prevention is uncertain. Subglottic secretion clearance by artificial cough maneuvers is promising, but more research is needed to assess its clinical feasibility. Continuous cuff-pressure management appears to be effective in reducing microaspiration of subglottic secretions.

Subglottic Secretion Drainage to Prevent Ventilator-Associated Pneumonia in Mechanically Ventilated Adult Patients: A Systematic Review and Meta-Analysis

Background: Patients requiring invasive mechanical ventilation in the intensive care unit (ICU) are at risk for ventilator-associated pneumonia (VAP). Objectives: To summarize the results of published, randomized, clinical trials (RCTs), a meta-analysis was performed to examine the effect of subglottic secretion drainage (SSD) on the prevalence and outcomes of VAP in adult patients undergoing mechanical ventilation. Methods: A comprehensive search based on specific terms was performed as a systematic review and meta-analysis by a computerized database search in the national and international databases including MagIran, SID, Scopus, PubMed, ISI Web of Knowledge, ScienceDirect, Google Scholar, Cochrane Central, and IRCT as well as references from 1990 to 2018 in English and Persian languages. RCTs of SSD were considered as common care of adult patients undergoing mechanical ventilation in the current meta-analysis. Data analysis was carried out through the random and fixed effects model, and the heterogeneity was investigated by I2 and Q-Cochrane index. The data were analyzed using STATA 11. Results: A total of 24 eligible RCTs with 2434 patients were identified. The overall risk ratio for VAP was 14.7 (95% confidence interval (CI): 11.1 - 18.4); mortality 25.8 (95% CI: 17.3 - 34.3); length of ICU stay 13.4 (95% CI: 7.8 - 18.9) and hospital stay 23.2 (95% CI: 12.5 - 33.9); ventilation days 14.9 (95% CI: 7.3 - 22.6); airway secretion 10.2 (95% CI: 4.9 - 15.5); and APACHEII 19.5 (95% CI: 14.6 - 24.3). Conclusions: SSD is recommended to prevent VAP, and reduce mortality rate and the ICU LOS, especially in the high-risk patients undergoing mechanical ventilation for a long period of time.

Construction of the quality indicator system of continuous aspiration of subglottic secretion

Objective To construct a quality evaluation index system for continuous aspiration of subglottic secretion (CASS) , in order to provide references for clinical objective evaluation of the quality of this technology. Methods Based on the theory of structure-process-outcome model, through literature review, expert meeting, expert consultation and principal component analysis, the quality evaluation index system and the index weights of all indicators for CASS were finally determined by 23 intensive care unit experts from 5 provinces (autonomous regions) and 11 cities through two rounds of consultation. SPSS 18.0 software was used in statistical analysis. Results The effective responsive rate of the questionnaires in the two rounds were 92.0%, 87.0%; the expert authority coefficients were 0.887, 0.895; Kendall's idea coordination coefficients were 0.13, 0.09 (P<0.01) .The final index system consisted of 3 first-level indicators, 8 second-level indicators, and 23 third-level indicators. Conclusions The process of the construction of nursing quality evaluation index system for CASS is scientific, and the contents of index entries are reasonable, which can ensure the effective implementation of the technology. Key words: Intensive care unit; Subglottic secretion; Aspiration technology; Quality assessment; Delphi method

The interaction of subglottic drainage, cuff pressure, and oral care on endotracheal tube fluid leakage: A benchtop study

BackgroundThe types of endotracheal tube, positive end-expiratory pressure (PEEP) level, endotracheal tube cuff pressure level, and nursing activity may influence the occurrence of pulmonary aspiration in ventilated patients with an endotracheal tube, but the evidence on their degree of influence is still inconclusive. AimThe aim of this study was to examine the effect of endotracheal tubes with or without subglottic secretion drainage on fluid leakage across endotracheal tube cuffs under different PEEP levels, different cuff pressures, and with or without oral care. MethodThis was a benchtop study with a multifactorial experimental design using two sets of airway. The two types of endotracheal tubes were tested through 12 scenarios with 240 combinations of different PEEP levels (0, 5, and 10 cmH2O), endotracheal tube cuff pressures (15 and 25 cmH2O), and oral care (with or without) using two sets of airway manikins. Each scenario lasted for 30 min, and fluid leakage was measured at the end of each scenario. Generalised Linear Model test was used to analyse fluid leak at 30 min (with and without interaction effect). ResultsA total of 100 cases showed fluid leakage, with more fluid leakage occurring in low cuff pressure (15 cmH2O), no PEEP, and with oral care. Results of the Generalised Linear Model revealed that endotracheal tubes with subglottic secretion drainage, high PEEP (at 10 cmH2O), normal cuff pressure (at 25 cmH2O), and no oral care demonstrated a significant effect in reducing fluid leakage than endotracheal tubes without subglottic secretion drainage, low PEEP (at 5 or 0 cmH2O), and low cuff pressure (at 15 cmH2O) (all p < 0.001). However, only the interaction effect of endotracheal tubes with subglottic secretion drainage*high PEEP showed a significant effect on fluid leakage (p < 0.001), with the combination of endotracheal tube*no PEEP producing the greatest volume of fluid leak. ConclusionUsing endotracheal tubes with subglottic secretion drainage, high PEEP, and normal cuff pressure and avoiding excessive endotracheal tube movement during oral care reduced fluid leakage. This study provided strong evidence to inform practice on reducing microaspiration in ventilated patients.

Relation Between the Volume of Subglottic Secretion and Risk of Extubation Failure in ICU Patients (SEGEX)

Relation Between the Volume of Subglottic Secretion and Risk of Extubation Failure in ICU Patients (SEGEX)

Investigating the Role of Subglottic Secretions Suctioning in the Prevention of ‎Ventilator Associated Pneumonia in Patients With Invasive Mechanical ‎Ventilation

BACKGROUND: development of ventilator associated pneumonia (VAP) leads to &amp;lrm;prolonged hospital stay, increased health care cost, and mortality rates. Subglottic &amp;lrm;secretion drainage through a dedicated endotracheal tube has been advocated as a mean &amp;lrm;to decrease the incidence of VAP and thereby assisting in &amp;lrm;the decrease of morbidity associated with invasive mechanical ventilation.&amp;lrm;&#x0D; &#x0D; OBJECTIVE: Investigate the role of subglottic secretion suctioning in the prevention of VAP in mechanically ventilated patients in intensive care unit.&amp;lrm;&#x0D; &#x0D; METHODS: A cross sectional study done in the intensive care unit of Ghazi Al-Hariri &amp;lrm;hospital for surgical specialties in medical city complex, 30 patients who &amp;lrm;are in need for invasive mechanical ventilation were intubated with endotracheal tube &amp;lrm;that have special port for subglottic secretion suctioning. Daily monitoring of patients &amp;lrm;clinical and radiological data to detect features of VAP was &amp;lrm;done, and if there was a suspicion of pneumonia, culture for tracheal aspirate performed &amp;lrm;to confirm diagnosis.&amp;lrm;&#x0D; &#x0D; RESULTS: &amp;lrm;Patient&amp;rsquo;s age was 37.1 &amp;plusmn; &amp;lrm;&amp;lrm;15.39 years, the highest proportion of study patients was found in &amp;lrm;age group &amp;lt; 30 and &amp;lrm;&amp;lrm;30&amp;ndash;49 years (40% in &amp;lrm;each group), most of the patients were males (70%) with a male to female ratio of &amp;lrm;&amp;lrm;2.33:1&amp;lrm;&amp;rlm;, &amp;rlm;Subglottic secretion suctioning lead to reduction in VAP by relative risk (95%CI) of &amp;rlm;&amp;lrm;0.167 (0.045&amp;ndash;0.559)&amp;lrm;&amp;rlm;, p-&amp;rlm;value = 0.001. &amp;rlm;Twenty eight patients didn&amp;rsquo;t show any sign, symptoms &amp;lrm;or radiological features suggesting a &amp;lrm;diagnosis of pneumonia while two patients developed &amp;lrm;features of pneumonia (suggestive signs and &amp;lrm;symptoms, radiological features and &amp;lrm;positive culture of tracheal aspirate).&amp;lrm;&#x0D; &#x0D; CONCLUSION: the use of endotracheal tube with subglottic &amp;lrm;secretions suctioning can have a role in the prevention of VAP in mechanically ventilated patients.&amp;lrm;

Prevention of Lung Bacterial Colonization With a Leak-Proof Endotracheal Tube Cuff: An Experimental Animal Study.

Endotracheal tubes with standard polyvinyl chloride cuffs create folds on inflation into the trachea, which lead to potential leakage of subglottic secretions into the lower airways and cause lung colonization and pneumonia. The use of a double-layer prototype leak-proof cuff has shown effective prevention of the fluid leakage across the cuff. We hypothesized that the use of such a leak-proof cuff could prevent lung bacterial colonization in vivo. To simulate patients in the ICU, 13 pigs were placed in the semirecumbent position, intubated, and mechanically ventilated for 72 h. Five animals were prospectively intubated with an endotracheal tube with a leak-proof cuff (leak-proof cuff group). Data from 8 animals previously intubated with an endotracheal tube with a standard polyvinyl chloride cuff (standard cuff group) were retrospectively analyzed. Leakage of tracheal secretions across the leak-proof cuff was tested by the macroscopic methylene blue evaluation. Arterial blood gas exchanges and microbiology were tested in all the pigs at necropsy. In the standard cuff group, all the pigs showed heavy bacterial colonization of the lungs after 72 h of mechanical ventilation, with an overall proportion of colonized lung lobes of 92% (44/48 lobes, 8/8 animals) compared with 27% (8/30 lobes, 5/5 animals) in the leak-proof cuff group (P < .001). These results were strengthened by the absence of methylene blue in the tracheal secretions below the leak-proof cuff. Furthermore, no hypoxemia was demonstrated in the pigs in the leak-proof cuff group after the 72-h experiment (PaO2 /FIO2 change from baseline, leak-proof cuff group vs standard cuff group; median difference 332, 95% CI 41-389 mm Hg; P = .030). A new leak-proof cuff for endotracheal intubation prevented macroscopic leakage of subglottic secretions along the airways. This mechanism led to the reduction of lung bacterial colonization, which could contribute to the prevention of hypoxemia in the pigs on mechanical ventilation while in the semirecumbent position.

Drug Prevention and Control of Ventilator-Associated Pneumonia.

Ventilator-associated pneumonia (VAP) is one of the most prevalent and serious complications of mechanical ventilation, which is considered a common nosocomial infection in critically ill patients. There are some great options for the prevention of VAP: (i) minimize ventilator exposure; (ii) intensive oral care; (iii) aspiration of subglottic secretions; (iv) maintain optimal positioning and encourage mobility; and (v) prophylactic probiotics. Furthermore, clinical management of VAP depends on appropriate antimicrobial therapy, which needs to be selected based on individual patient factors, such as previous antibacterial therapy, history of hospitalization or mechanical ventilation, and bacterial pathogens and antibiotic resistance patterns. In fact, antibiotic resistance has exponentially increased over the last decade, and the isolation of a multidrug-resistant (MDR) pathogen has been identified as an independent predictor of inadequate initial antibiotic therapy and which is significantly associated with increased mortality. Multiple attempts were used in the treatment of VAP, such as novel antibacterial agents, inhaled antibiotics and monoclonal antibodies. In this review, we summarize the current therapeutic options for the prevention and treatment of VAP, aiming to better management of VAP in clinical practice.

Efficacy of Two Intermittent Subglottic Secretion

Efficacy of Two Intermittent Subglottic Secretion

Unintentional endotracheal tube cuff deflation during routine checks: a simulation study.

Endotracheal tube cuff pressures should be maintained between 20 and 30 cm H2 O to prevent the aspiration of subglottic secretions past the cuff. Guidance recommends regular monitoring of the cuff pressure, performed using a handheld manometer/inflator. Poor technique can lead to transient deflation of the cuff, leading to the bolus aspiration of upper respiratory tract secretions, tracheal colonization and, ultimately, ventilator-associated pneumonia. To determine whether intensive care staff transiently deflate the endotracheal tube cuff to below 20 cm H2 O during routine cuff pressure checks when using a handheld manometer/inflator device. This was an exploratory simulation study. A sample of medical (n = 10) and nursing staff (n = 10), capable of caring for a tracheally intubated patient, participated in the study on a single day. A mannequin was intubated with a standard oral endotracheal tube with the cuff pressure set at 50 cm H2 O. Participants were required to check and correct the cuff pressure to the appropriate level with a manometer. The lowest attained and the final target pressures were recorded. Three doctors were unfamiliar with the manometer and did not attempt measurement. During cuff pressure readjustment, 59% (10/17) of participants transiently deflated the cuff below 20 cm H2 O and then re-inflated to attain the final pressure. Of these participants, four deflated the cuff pressure to 0 cm H2 O before re-adjusting it back into range. Most participants, 88% (15/17), corrected the final cuff pressure to between 20 and 30 cm H2 O. Poor technique when using the manometer led to unintentional cuff deflation during routine checks. In clinical practice, this could increase the risk of pulmonary aspiration and ventilator-associated pneumonia. Further research into alternatives for handheld manometers, such as automated continuous cuff pressure monitors, is warranted. Cuff deflations can easily occur during routine cuff pressure checks. Staff should be aware of the implications of cuff deflations and seek to improve training with manometers.

Subglottic secretion drainage for ventilator-associated pneumonia prevention: an underused efficient measure.

Subglottic secretion drainage (SSD) is one of the recommended strategies to prevent ventilator-associated pneumonia (VAP) with a high level of evidence, especially regarding early-onset pneumonia. All meta-analysis found that the use of SSD reduces VAP occurrence with a relative risk (RR) reduction of 45%. In some of them, SSD reduces the duration of mechanical ventilation (MV) but without beneficial effect on intensive care unit (ICU) or hospital mortality. In spite of the edited recommendations, SSD has not been widely implemented in ICUs and remains underused. Several factors could account for this: doubts on the innocuousness of using SSD, persisting reservations on the SSD effect on other outcomes than VAP, a high variability in the volume of secretions suctioned between patients and, for each individual patient, during the period of MV and the initial increased expense of the specific endotracheal tubes (ETs) allowing SSD which limits the availability of these devices.

Impact of subglottic secretion drainage on microaspiration in critically ill patients: a prospective observational study.

Microaspiration is a major factor in ventilator-associated pneumonia (VAP) pathophysiology. Subglottic secretion drainage (SSD) aims at reducing its incidence. Single-center prospective observational study, performed in a French intensive care unit (ICU) from March 2012 to April 2013, including adult patients mechanically ventilated for at least 24 hours divided in two groups: patients in the SSD group intubated using tracheal tubes allowing SSD and patients in the control group intubated with standard tracheal tubes. Pepsin and salivary amylase concentrations were measured for 24 hours in all tracheal aspirates. Primary objective was to determine the impact of SSD on gastric or oropharyngeal microaspiration using pepsin or amylase concentration in tracheal aspirates. Fifty-five patients were included in the SSD group and 45 in the control group. No difference was found between groups regarding the incidence of microaspiration defined as at least one tracheal aspirate positive for either pepsin or amylase [49 (89%) vs. 37 (82%), P=0.469]. Percentage of patients with VAP [16 (29%) vs. 11 (24%), P=0.656], ventilator-associated tracheobronchitis (VAT) [7 (13%) vs. 4 (9%), P=0.750] or early airway colonization [15 (35%) vs. 8 (18%), P=0.219] were not significantly different in study groups. SSD did not reduce the incidence of microaspiration, VAP, VAT or airway colonization in this observational study.

Excess Mucin Impairs Subglottic Epithelial Host Defense in Mechanically Ventilated Patients.

Aspiration of infective subglottic secretions causes ventilator-associated pneumonia (VAP) in mechanically ventilated patients. Mechanisms underlying subglottic colonization in critical illness have not been defined, limiting strategies for targeted prevention of VAP. To characterize subglottic host defense dysfunction in mechanically ventilated patients in the ICU; to determine whether subglottic mucin contributes to neutrophil phagocytic impairment and bacterial growth. Prospective subglottic sampling in mechanically ventilated patients (intubated for four or more days), and newly intubated control patients (intubated for less than 30 min); isolation and culture of primary subglottic epithelial cells from control patients; laboratory analysis of host innate immune defenses. Twenty-four patients in the ICU and 27 newly intubated control patients were studied. Subglottic ICU samples had significantly reduced microbiological diversity and contained potential respiratory pathogens. The subglottic microenvironment in the ICU was characterized by neutrophilic inflammation, significantly increased proinflammatory cytokines and neutrophil proteases, and altered physical properties of subglottic secretions, including accumulation of mucins. Subglottic mucin from ICU patients impaired the capacity of neutrophils to phagocytose and kill bacteria. Phagocytic impairment was reversible on treatment with a mucolytic agent. Subglottic mucus promoted growth and invasion of bacterial pathogens in a novel air-liquid interface model of primary human subglottic epithelium. Mechanical ventilation in the ICU is characterized by substantial mucin secretion and neutrophilic inflammation. Mucin impairs neutrophil function and promotes bacterial growth. Mucolytic agents reverse mucin-mediated neutrophil dysfunction. Enhanced mucus disruption and removal has potential to augment preventive benefits of subglottic drainage.

Effect of the improved continuous subglottic approach in patients with mechanical ventilation

Objective To investigate the clinical effect of the improved continuous subglottic approach in patients with mechanical ventilation. Methods A total of 90 ICU patients with mechanical ventilation, were divided into observation group and control group 1 and control group 2 by random digits table method,each group was 30 cases.The observation group used the improved continuous subglottic suction. The control group 1 used the way of continuous 24 h suction under glottis. The control group 2 used the way of every 2 h suction under glottis combined with subglottic. The incidence of ventilator-associated pneumonia (VAP), the rate of tube blockage, the amount of subglottic secretion and the damage of airway mucosa were observed. Results The incidence of 7 d VAP in the observation group was 3.33%(1/30), which was not significantly different from that in the control group 1 and the control group 2 (P>0.05), but it was lower than the incidence of VAP at home and abroad. The rate of plugging in the observation group was 6.67%(2/30), and that in the control group 1 was 23.33%(7/30), and the difference was statistically significant (χ2=4.320, P<0.05). The daily flow rate of subglottic secretion was (30.93 ± 8.01) ml/d in the observation group, and (19.75 ± 6.52) ml/d in the control group 2, the difference was statistically significant (t=7.542, P<0.05). The injury rate of airway mucosa in the observation group was 10.00% (3/30), and 33.33%(10/30) in the control group 1, the difference was statistically significant (χ2=4.812, P<0.05). Conclusions The improvement suction under glottis method can be widely applied in clinical practice,which can effectively reduce the incidence of VAP, subglottic tube plugging rate, fully drainage of subglottic secretions, the degree of airway mucosa damage, reduce nursing workload compared with intermittent subglottic. Key words: Respiration, artificial; Improvement; Subglottic aspiration

To assess the efficacy of subglottic aspiration in prevention of ventilator-associated pneumonia

Background: The present study was conducted to assess the efficacy of subglottic aspiration in prevention of ventilator-associated pneumonia. Materials and methods: The present study was conducted on 120 patients hospitalized for critical illness of both genders. They were divided into 2 groups of 60 each. Group I (n = 60) patients were intubated with HiLo™ Evac endotracheal tube with sub-glottic secretion suction. Group II patients (n = 60) were intubated with HiLo™ Contour endotracheal tube without such facility. Presence of VAP day of onset of VAP after instituting mechanical ventilation, length of mechanical ventilation, length of ICU stay and mortality was recorded. Results: Incidence of VAP in group I was 4.2 days and in group II was 10 days. Ventilator days (at onset of VAP) in group I was 7.12 and in group II was 8.45, length of ICU stay (at onset of VAP) in group I was 8.45 and in group II was 6.24, total ventilator days in group I was 6.12 and in group II was 8.22, mortality was 11 in group I and 25 in group II. The difference was significant (P< 0.05). Conclusion: Authors found that intermittent sub-glottic suctioning reduces the incidence of VAP including late-onset VAP.