Predicting Which Patients will Likely Benefit from Subglottic Secretion Drainage Endotracheal Tubes: A Retrospective Study

Darren P Mareiniss; Tim Xu; Julius Cuong Pham; Yu-Hsiang Hsieh; Jiawei Zhao; Christopher Nguyen; Michael Nguyen; Bradford Winters

doi:10.1016/j.jemermed.2015.10.039

Predicting Which Patients will Likely Benefit from Subglottic Secretion Drainage Endotracheal Tubes: A Retrospective Study

J Emerg Med. 2016 Mar;50(3):385-93. doi: 10.1016/j.jemermed.2015.10.039. Epub 2016 Jan 21.

Authors

Darren P Mareiniss¹, Tim Xu², Julius Cuong Pham³, Yu-Hsiang Hsieh⁴, Jiawei Zhao², Christopher Nguyen⁴, Michael Nguyen⁴, Bradford Winters⁵

Affiliations

¹ Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
² The Johns Hopkins School of Medicine, Baltimore, Maryland.
³ Department of Emergency Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.
⁴ Department of Emergency Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.
⁵ Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.

PMID: 26806317
DOI: 10.1016/j.jemermed.2015.10.039

Abstract

Background: Subglottic secretion drainage endotracheal tubes (SSD ETTs) have been shown to decrease ventilator-associated pneumonia and are recommended for patients intubated > 48 h or 72 h. However, it is difficult to determine which patients will be intubated > 48 h or 72 h at the time of intubation.

Objective: We attempted to determine which patient characteristics were associated with intubations ≥ 48 h or 72 h in order to guide proper placement of SSD ETTs.

Methods: The medical records of 2,159 ventilated patients at a single institution were retrospectively reviewed for intubation duration, age, sex, race, body mass index, weight, intubation reason, whether the intubation was emergent, operative status, intensive care unit (ICU) diagnosis, intubation location, ICU location, comorbidities (e.g., congestive heart failure, chronic obstructive pulmonary disorder, coronary artery disease, dementia, and liver disease), acute kidney injury (AKI), and chronic renal injury. A multivariate regression analysis was then performed with all reliable data.

Results: The following were associated with intubation ≥ 48 h: neuroscience critical care unit (NCCU) admission (risk ratio [RR] = 1.85; 95% confidence interval [CI] 1.34-2.56), emergent intubation (RR = 1.97; 95% 1.28-3.03), comorbid dementia (RR = 2.31; 95% 1.28-4.18), nonoperative intubation (RR = 1.77; 95% 1.28-4.18), and AKI (RR = 3.32; 95% 2.56-4.3). The following were independently associated with intubation ≥ 72 h: NCCU admission (RR = 2.2; 95 CI 1.57-3.08), nonoperative intubation (RR = 3.38; 95% CI 2.63-4.35), comorbid dementia (RR = 3.03; 95% CI 1.67-5.48), and AKI (RR = 3.11; 95% CI 2.38-4.07).

Conclusion: Nonoperative intubation, emergent intubation, history of dementia, admission to NCCU and AKI all appear to be independently associated with increased RRs for either ≥ 48 h or 72 h of ventilation.

Keywords: VAP; intubation; prevention; subglottic secretion drainage endotracheal tubes; ventilator-associated pneumonia.

MeSH terms

Adolescent
Adult
Aged
Drainage / methods*
Female
Glottis
Humans
Intubation, Intratracheal / methods*
Intubation, Intratracheal / statistics & numerical data
Male
Middle Aged
Pneumonia, Ventilator-Associated / prevention & control*
Retrospective Studies
Time Factors
Young Adult