The effect of subglottic secretion drainage on the incidence of ventilator associated pneumonia

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2017 Dec;161(4):374-380. doi: 10.5507/bp.2017.041. Epub 2017 Oct 17.

Abstract

Background: Ventilator-Associated Pneumonia (VAP) is an undesired side effect of mechanical ventilation in intensive care units (ICUs).

Aim: We evaluated whether endotracheal tubes with subglottic secretion drainage (SSD) would reduce the incidence of VAP among patients undergoing mechanical ventilation in an ICU.

Methods: The analysis of medical records of patients undergoing mechanical ventilation exceeding 48 h who were hospitalised in ICUs between 2007 and 2014 led to separating two groups of patients: those in whom no subglottic drainage was applied (NSSD) (records dating from 2007-2010) and those whose treatment involved endotracheal tubes with subglottic secretion drainage (SSD) (records dating from 2011-2014).

Results: Analysis of 1807 patients hospitalised in ICUs (804 NSSD patients and 1003 SSD patients). A difference was found in the frequency of VAP incidence between the groups (P<0.001). In the NSSD group as many as 84 cases were reported (incidence: 10.7%), and in the SSD group - 43 cases (incidence: 5.2%). The odds ratio (OR) and relative risk (RR) was 2.5. The probability of VAP was significantly higher in the NSSD group. The risk factors of VAP incidence (P<0.001) included the correlation between reintubation (R=0.271), tracheostomy (R=0.309) and bronchoscopy (R=0.316).

Conclusion: Use of endotracheal tubes with subglottic secretion drainage in patients in the ICU on mechanical ventilation significantly reduced the incidence of VAP.

Keywords: endotracheal tube (ETT); subglottic secretion drainage (SSD); ventilator-associated pneumonia (VAP).

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Bodily Secretions
  • Child
  • Child, Preschool
  • Drainage* / instrumentation
  • Female
  • Glottis
  • Humans
  • Incidence
  • Infant
  • Intubation, Intratracheal / adverse effects*
  • Intubation, Intratracheal / instrumentation
  • Male
  • Middle Aged
  • Pneumonia, Ventilator-Associated / epidemiology*
  • Pneumonia, Ventilator-Associated / etiology*
  • Pneumonia, Ventilator-Associated / prevention & control
  • Retrospective Studies
  • Risk Factors
  • Young Adult