A Randomized Clinical Trial of Intermittent Subglottic Secretion Drainage in
Patients Receiving Mechanical Ventilation

Smulders K, van der Hoeven H, Weers-Pothoff I, Vandenbroucke-Grauls, C. Chest. 2002;121:858-862.

Objective

To study the effect of subglottic secretions drainage on the incidence of ventilator-associated pneumonia (VAP) in patients receiving mechanical ventilation.

Methods

The study was conducted in a 12-bed general ICU. One hundred fifty patients with an expected duration of mechanical ventilation of >72 hours were enrolled in the study. Patients were randomly assigned to receive either an endotracheal tube designed for subglottic secretion drainage or a standard endotracheal tube. In the subglottic drainage group, intermittent suction was applied at 100 mm Hg with a 20-second interval and duration of 8 seconds. The incidence of VAP, duration of mechanical ventilation, length of ICU stay, length of hospital stay and mortality were measured for both groups.

Results

Seventy-five patients were randomized to the test group receiving subglottic secretion drainage, and 75 patients were randomized to the control group receiving regular endotracheal tubes. The two groups were similar at the time of randomization with respect to age, other demographic characteristics, severity of illness and underlying disease. Three patients (4%) in the test group receiving subglottic secretion suctioning via the
endotracheal tube were diagnosed with VAP. In the control group, 12 patients (16%) were
diagnosed with VAP (relative risk, 0.22; 95%CI, 0.06 to 0.81; p=0.014). The other outcome measures were not significantly different between the two groups.

Conclusion

"Intermittent subglottic secretion drainage reduces the incidence of VAP in patients receiving mechanical ventilation.”

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