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Zhou J, Tian Y, Li HL. Subcutaneous emphysema potentially caused by tracheostomy tubes with subglottic suction devices. Can J Anaesth 2024; 71:555-556. [PMID: 38366212 PMCID: PMC10978720 DOI: 10.1007/s12630-024-02700-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/11/2024] [Accepted: 01/22/2024] [Indexed: 02/18/2024] Open
Affiliation(s)
- Jianfang Zhou
- Department of Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ye Tian
- Department of Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hong-Liang Li
- Department of Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Du J, Chengcong N, Wu X. Volume-based subglottic secretion drainage: a randomized controlled trial. Ann Med Surg (Lond) 2024; 86:1426-1432. [PMID: 38463058 PMCID: PMC10923278 DOI: 10.1097/ms9.0000000000001695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/27/2023] [Indexed: 03/12/2024] Open
Abstract
Background This study proposed to explore individual management mode for patients with subglottic secretion drainage. Methods Randomly chosen within the hospital ICU 68 patients from 7 April to 15 June 2023, all the patients randomly assigned to the control group or observation group, and control group adopts the model of intermittent drainage management, observation group based on the volume of subglottic secretion in patients with individualized management, and then analysis the two groups of patients clinical trial results. Results The clinical trial results showed that there were statistically significant differences (P<0.05) between the control group and the observation group in the incidence of tube blockage events (11 vs. 2), average diurnal pumping frequency (9 vs. 7, 5 vs. 4) between the two groups and the patient satisfaction scores (6 vs. 7), In the partial mucosa injure (22 vs 19) and VAP (5 vs. 1) there were no statistically significant difference (P>0.05). Although there was no statistically significant difference (P>0.05) in the average aspiration volume (12.68±3.41 vs. 12.19±2.68, 8 vs. 8) between the two groups, but the management mode of the observation group indicated that based on patient secretion volume was more consistent with the characteristics of the body's diurnal metabolic differences, because there was a big difference between the average total amount of daytime and nighttime suction between the two groups. Conclusion Individualized management based on the volume of subglottic secretions produced by patients can further optimize the airway management of patients and reduce the risk of adverse events of subglottic secretions aspiration.
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Lee S, Choi JH. Do endotracheal tubes with subglottic suction devices cause airway injury? Can J Anaesth 2023; 70:1539-1540. [PMID: 37280452 DOI: 10.1007/s12630-023-02516-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 06/08/2023] Open
Affiliation(s)
- Sangho Lee
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Jeong-Hyun Choi
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea.
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Sibley S. In reply: Do endotracheal tubes with subglottic suction devices cause airway injury? Can J Anaesth 2023; 70:1541. [PMID: 37280453 DOI: 10.1007/s12630-023-02517-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 06/08/2023] Open
Affiliation(s)
- Stephanie Sibley
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.
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Adi O, Fong CP, Sallehuddin RM, Ahmad AH, Sum KM, Yusof ZM, Via G, Tavazzi G. Airway ultrasound to detect subglottic secretion above endotracheal tube cuff. Ultrasound J 2023; 15:23. [PMID: 37148375 PMCID: PMC10164205 DOI: 10.1186/s13089-023-00318-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/31/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Subglottic secretion had been proven as one of the causes of microaspiration and increased risk of ventilator-associated pneumonia (VAP). The role of ultrasound to detect subglottic secretion has not yet been established. PURPOSE The purpose of this study is to determine the sensitivity and specificity of upper airway ultrasound (US) in the detection of subglottic secretions as compared to computed tomography (CT) scanning. MATERIAL AND METHODS A prospective observational study was carried out in adult trauma patients requiring mechanical ventilation and cervical CT scan. All patients had an endotracheal tube cuff-pressure maintained between 20 and 30 cm H2O. Airway US was performed at the bedside immediately before the patient was transferred to the CT scan suite. The sensitivity, specificity, and positive/negative predictive values (PPV, NPV) of the upper airway US detection of subglottic secretions were then calculated and compared with CT findings. RESULTS Fifty participants were consecutively included. Subglottic secretions were detected in 31 patients using upper airway US. The sensitivity and specificity of upper airway US in detecting subglottic secretion were 96.7% and 90%, respectively (PPV 93.5%, NPV 94.7%). 18 (58%) patients with subglottic secretions developed VAP during their ICU stay (p = 0.01). The area under the receiver operating curve (AUROC) was 0.977 (95% CI 0.936-1.00). CONCLUSIONS Upper airway US is a useful tool for detecting subglottic secretions with high sensitivity and specificity. CLINICAL IMPLICATIONS This study shows: 1. Upper airway US may aid in detecting subglottic secretions, which are linked to VAP. 2. Detecting subglottic secretions at the bedside aids in determining the best frequency of subglottic aspiration to clean the subglottic trachea. 3. Upper airway US may also aid in detecting the correct ETT position. Trial registration Clinicaltrials.gov. CLINICALTRIALS gov identifier NCT04739878 Date of registration 2nd May 2021 URL of trial registry record https://clinicaltrials.gov/ct2/show/NCT04739878 .
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Affiliation(s)
- Osman Adi
- Resuscitation and Emergency Critical Care Unit (RECCU), Trauma and Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia.
| | - Chan Pei Fong
- Resuscitation and Emergency Critical Care Unit (RECCU), Trauma and Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | | | - Azma Haryaty Ahmad
- Resuscitation and Emergency Critical Care Unit (RECCU), Trauma and Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Kok Meng Sum
- Department of Anesthesiology and Intensive Care, Beacon Hospital, No. 1, Jalan 215, Off Jalan Templer, Section 51, 46050, Petaling Jaya, Selangor, Malaysia
| | - Zulrushdi Md Yusof
- Department of Radiology, Raja Permaisuri Bainun Hospital, Jalan Raja Ashman (Jalan Hospital), Ipoh, Perak, Malaysia
| | - Gabriele Via
- Cardiac Anesthesia and Intensive Care - Cardiocentro Ticino, Lugano, Switzerland
| | - Guido Tavazzi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, DEA Piano-1, Fondazione IRCCS Policlinico S. Matteo, Viale Golgi 19, 27100, Pavia, Italy
- Department of Anesthesia and Intensive Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
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6
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Sibley SR, Ball IM, D'Arsigny CL, Drover JW, Erb JW, Galvin IM, Howes DW, Ilan R, Messenger DW, Moffatt SL, Parker CM, Ridi S, Muscedere J. Airway injury from the presence of endotracheal tubes and the association with subglottic secretion drainage: a prospective observational study. Can J Anaesth 2022; 69:1507-1514. [PMID: 36198992 DOI: 10.1007/s12630-022-02333-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/09/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Laryngeal and tracheal injuries are known complications of endotracheal intubation. Endotracheal tubes (ETTs) with subglottic suction devices (SSDs) are commonly used in the critical care setting. There is concern that herniation of tissue into the suction port of these devices may lead to tracheal injury resulting in serious clinical consequences such as tracheal stenosis. We aimed to describe the type and location of tracheal injuries seen in intubated critically ill patients and assess injuries at the suction port as well as in-hospital complications associated with those injuries. METHODS We conducted a prospective observational study of 57 critically ill patients admitted to a level 3 intensive care unit who were endotracheally intubated and underwent percutaneous tracheostomy. Investigators performed bronchoscopy and photographic evaluation of the airway during the percutaneous tracheostomy procedure to evaluate tracheal and laryngeal injury. RESULTS Forty-one (72%) patients intubated with ETT with SSD and sixteen (28%) patients with standard ETT were included in the study. Forty-seven (83%) patients had a documented airway injury ranging from hyperemia to deep ulceration of the mucosa. A common tracheal injury was at the site of the tracheal cuff. Injury at the site of the subglottic suction device was seen in 5/41 (12%) patients. There were no in-hospital complications. CONCLUSIONS Airway injury was common in critically ill patients following endotracheal intubation, and tracheal injury commonly occurred at the site of the endotracheal cuff. Injury occurred at the site of the subglottic suction port in some patients although the clinical consequences of these injuries remain unclear.
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Affiliation(s)
- Stephanie R Sibley
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Ian M Ball
- Division of Critical Care Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | | | - John W Drover
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Jason W Erb
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Imelda M Galvin
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Daniel W Howes
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Roy Ilan
- Division of Critical Care Medicine, Rambam Health Care Campus, Haifa, Israel
| | - David W Messenger
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Susan L Moffatt
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | | | - Stacy Ridi
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
| | - John Muscedere
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
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Anand R, Singh S, Prasoon A, Kumar S, Singh R, Nayan SK. 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. JOURNAL OF CARDIAC CRITICAL CARE TSS 2022. [DOI: 10.1055/s-0041-1741524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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.
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Affiliation(s)
- Ravi Anand
- Department of Trauma and Emergency, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Siddhart Singh
- Department of Critical Care Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Anand Prasoon
- Department of Trauma and Emergency, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Sanjeev Kumar
- Department of Critical Care Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Ritu Singh
- Department of Critical Care Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Santosh Kumar Nayan
- Department of Trauma and Emergency, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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Isac C, Samson HR, John A. Prevention of VAP: Endless evolving evidences-systematic literature review. Nurs Forum 2021; 56:905-915. [PMID: 34091899 DOI: 10.1111/nuf.12621] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/30/2021] [Accepted: 05/24/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Prevention of ventilator associated pneumonia (VAP) is the focus in critical care units. Immunocompromised patients, older adults, and postoperative patients are at greater risk for VAP. With the dynamic changes in the empirical world, updated evidence must be used to guide the standard of practice. This literature review assimilates the recent evidence for VAP prevention. METHOD The Preferred Reporting Items for Systematic Reviews and Meta-analysis framework guided the selection of the included research articles. Medline, EBSCO host, CINAHL, UpToDate and Google Scholar databases explored, for relevant publications between 2010 and 2020. The quality of evidence for the 14 studies selected were rated using the hierarchy of quantitative research designs. RESULTS Evidence-based VAP preventive strategies are prevention of aspiration, minimizing ventilator days, reducing the pathogen load, safe endotracheal suction practices, and pharmaceutical preventive measures. The mandates for VAP preventive measures among coronavirus disease 2019 (COVID-19) patients is included. CONCLUSION Though some of these themes identify with the past, the nuances in their implementation are highlights of this review. The review reiterates the need to revisit ambiguous practices implemented for VAP prevention. Adherence to evidence-based practices, by education, training, and reduction of workload is the key to VAP prevention.
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Affiliation(s)
- Chandrani Isac
- Adult Health & Critical Care, College of Nursing, Sultan Qaboos University, Al Khod, Muscat, Sultanate of Oman
| | - Hema Roslin Samson
- Adult Health & Critical Care, College of Nursing, Sultan Qaboos University, Al Khod, Muscat, Sultanate of Oman
| | - Anitha John
- Adult Health & Critical Care, College of Nursing, Sultan Qaboos University, Al Khod, Muscat, Sultanate of Oman
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Ebrahimian A, Tourdeh M, Paknazar F, Davari H. The Effect of the Open and Closed System Suctions on Pain Severity and Physiological Indicators in Mechanically Ventilated Patients with Traumatic Brain Injury: A Randomised Controlled Trial. Turk J Anaesthesiol Reanim 2019; 48:202-207. [PMID: 32551447 PMCID: PMC7279868 DOI: 10.5152/tjar.2019.03342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/13/2019] [Indexed: 11/22/2022] Open
Abstract
Objective Tracheal suctioning can cause pain and physiological indicator variations in patients with traumatic brain injury (TBI). The aim of the present study was to compare pain severity and physiological indicator variations during the closed tracheal suction system (CTSS) and open tracheal suction system (OTSS) in patients with TBI. Methods This study was a clinical trial. Samples included all ventilated patients with TBI. The patients were randomly divided into the OTSS and CTSS groups. In both groups, the Critical Care Pain Observation Tool (CPOT) and physiological indicators were recorded by three nurses prior to suctioning, the end of suctioning and 5 min after suction completion. Data were analysed using the independent t-test and repeated measurement tests. Results A total of 112 patients participated in the present study. Before the interventions, the mean value of the Glasgow Coma Scale was 6.45±1.13, blood pressure 128.33±20.54, saturated oxygen in arterial blood (SpO2) 96.74±2.76, respiratory rate (RR) 15.06±3.98, end-tidal CO2 (EtCO2) 36.2±21.98, heart rate 82.18±42.33 and CPOT-based pain 0.43±0.94 in the patients. Independent t-test was used to compare CTSS and OTSS, suggesting significant differences with respect to the mean values of SpO2, RR and EtCO2 immediately after suctioning. This test showed significant differences between the two groups with respect to pain intensity at all three points of measurement. The two groups were also found to be significantly different with respect to RR measured 5 min after suctioning (p<0.05). Conclusion Compared to OTSS, CTSS can cause higher reductions in pain levels during and after suctioning in patients with head traumas and can also cause higher improvements in physiological indicators, such as RR, O2 saturation and EtCO2.
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Affiliation(s)
- Abbasali Ebrahimian
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Maedeh Tourdeh
- School of Paramedicine, Qom University of Medical Sciences, Qom, Iran
| | - Fatemeh Paknazar
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Hossein Davari
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
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Ex Vivo Evaluation of Secretion-Clearing Device in Reducing Airway Resistance within Endotracheal Tubes. Crit Care Res Pract 2019; 2018:3258396. [PMID: 30652032 PMCID: PMC6311789 DOI: 10.1155/2018/3258396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/23/2018] [Accepted: 11/13/2018] [Indexed: 12/03/2022] Open
Abstract
Background Secretions accumulate in endotracheal tubes' (ETT) lumens upon their placement in patients. The secretions impact airway resistance and pressure. Secretions potentiate prolonged mechanical ventilation and ventilator-associated pneumonia. Our primary objective in this study was to evaluate an ETT-clearing device (ETT-CD) in its ability to remove secretions from ex vivo ETT lumens. Methods Forty ETTs, obtained from intensive care patients at extubation, were individually placed into a ventilator field performance testing simulator at 37°C. The pressure drop through the ETTs was measured at a flow rate of 60 L/min before and after cleaning with the ETT-CD and compared with unused, similarly sized controls tubes. The ETT-CD was inserted into an ETT until the tip reached Murphy's eye (hole in the side) of the ETT. The wiper, set back from the tip, was expanded by ETT-CD handle activation. As the ETT-CD was removed, the distal wiper extracted secretions from the ETT lumen. Results Forty ETTs were tested with nonparametric Wilcoxon signed-rank tests. Before being cleared with the ETT-CD, the median pressure drop in the extubated 7.5 mm ETTs was 17.8 cm H2O; after ETT-CD use, it was 12.3. The cleared ETTs were significantly improved over the ETTs before being cleared (p < 0.001); however, there remained a significant difference between the cleared ETTs and the control tubes (p=0.005), indicating the clearing was not to the level of an unused ETT. Similar results were determined for the 8.0 mm ETTs. Conclusions For the 7.5 mm and the 8.0 mm EETs, the ETT-CD improved effective patency of the ETTs over the uncleared ETTs, independent of occlusion location, tube size, or length of tube. However, there remained a significant difference between the cleared tubes and controls.
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Lacherade JC, Azais MA, Pouplet C, Colin G. Subglottic secretion drainage for ventilator-associated pneumonia prevention: an underused efficient measure. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:422. [PMID: 30581830 DOI: 10.21037/atm.2018.10.40] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Jean-Claude Lacherade
- District Hospital Center, Medical-Surgical Intensive Care Unit, La Roche-sur-Yon, France
| | - Marie-Ange Azais
- District Hospital Center, Medical-Surgical Intensive Care Unit, La Roche-sur-Yon, France
| | - Caroline Pouplet
- District Hospital Center, Medical-Surgical Intensive Care Unit, La Roche-sur-Yon, France
| | - Gwenhael Colin
- District Hospital Center, Medical-Surgical Intensive Care Unit, La Roche-sur-Yon, France
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