Continuous Aspiration of Subglottic Secretions – Impact on Ventilator-Associated Pneumonia in a General Intensive Care Unit

Garbarini P, Ryland B. Continuous Aspiration of Subglottic Secretions – Impact on Ventilator-Associated Pneumonia in a General Intensive Care Unit. Respiratory Care, 2003;48(11):1062. Abstract of poster presentation at American Association of Respiratory Care Annual Convention.

Purpose

The purpose of the study was to determine the impact of continuous aspiration of subglottic secretions (CASS) on rates of ventilator-associated pneumonia (VAP) in a community-based general intensive care unit (Sentara Healthcare, Virginia Beach, VA).

Methods

CASS ET tubes (Mallinckrodt^® Hi-Lo Evac^® endotracheal tube) replaced all adult tubes outside the Operating Room. The tubes were also placed in the OR for high-risk cases or those admitted to the ICU post-op. Continuous suction was applied at 20 mm Hg pressure using a distinctive-looking pediatric suction regulator (Boehringer Laboratories) with a maximum pressure of 100 mm Hg for safety.

Other infection control practices to reduce VAP were already in place and remained unchanged during the study. These practices included head of bed elevation >30º, passive humidification up to 72 hours, heated wire humidification to minimize breaking the ventilator circuit, circuit changes every 7 days and medication administration by MDI per protocol.

VAP rates after implementation were compared with rates prior to implementation. VAP was diagnosed according to the CDC guidelines.

Results

Conclusions

"Implementation of CASS resulted in a 52% decrease in VAP rates. This result is consistent with controlled studies reporting a 40-50% reduction in VAP rates. These results were achieved despite Apache II increased patient acuity over the study period.”