Prevention
of Nosocomial Pneumonia in Intubated Patients: Respective
Role
of Mechanical Subglottic Secretions Drainage and Stress Ulcer
Prophylaxis
Mahul Ph, Auboyer C, Jospe R, et al. Intensive Care Medicine. 1992;18:20-25.
Objective
To evaluate the prevention of
nosocomial pneumonia by two different modes:
- Prevention
of aspiration by mechanical drainage of subglottic
secretions (SSD) above the
tracheal cuff
- Prevention of gastric colonization by
prophylaxis of ulcer bleeding
Method
The study involved 145 patients intubated >3
days. All patients were intubated
with
an
endotracheal tube for subglottic secretions drainage. The
first randomization assigned patients to
either receive subglottic secretion drainage or no subglottic
secretion drainage. A second
randomization assigned patients to receive stress ulcer prophylaxis
with either antacids or
sucralfate. Four random groups were defined, similar in age
and severity of illness.
Results
Subglottic secretion drainage was
associated with:
- A twice-lower incidence
of nosocomial pneumonia. The incidence in patients with
no
subglottic secretion drainage (no-SSD) was 29.1%, while
the incidence in patients
receiving subglottic secretion drainage (SSD) was 12.8%
(p<0.05)
- A prolonged time of onset of
nosocomial pneumonia (no-SSD: 8.3 ± 5 days, SSD:
16.2± 11 days)
- A decrease in the colonization
rate from admission to end-point day in tracheal aspirates
(no-SSD: +21.3%, SSD: +6.6%) and in subglottic secretions
(no-SSD: +33.4%, SSD:
+2.1%)
- Sucralfate was not associated
with a significantly lower incidence of nosocomial
pneumonia (antacids: 23.6%, sucralfate: 17.8%), but was
associated with a lower
increase in the colonization rate in subglottic and gastric
aspirates, from admission to
end-point day
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