Continuous Aspiration of Subglottic Secretions in Preventing Ventilator-
Associated Pneumonia

Valles J, Artigas A, Rello J, et al. Annals of Internal Medicine. 1995;122:179-186.

Objective

To determine whether continuous aspiration of subglottic secretions prevents nosocomial
pneumonia in mechanically ventilated patients.

Methods

The study included 190 patients who were admitted to the intensive care unit and whose
condition suggested the need for intubation >3 days. All patients were intubated with an
endotracheal tube for continuous aspiration of subglottic secretions. Seventy-six patients were randomly assigned to receive continuous aspiration of subglottic secretions, and 77 control patients were assigned to receive no subglottic secretion drainage. The numbers of cases of ventilator-associated pneumonia, ventilated days, days in the ICU, and deaths were recorded. The amount of subglottic secretions aspirated daily and surveillance cultures in the subglottic secretions were also obtained periodically.

Results

The incidence rate of ventilator-associated pneumonia (VAP) was 19.9 incidences/1000 ventilator days in the group receiving continuous aspiration of subglottic secretions, and 39.6 episodes/1000 ventilator days in the control group (relative risk 1.98; 95% CI, 1.03 to 3.82). Episodes of VAP occurred later in patients receiving continuous aspiration than in the control patients (12.0 ± 7.1 days vs. 5.9 ± 2.1 days, P=0.003). The same microorganisms isolated from protected specimen brush or bronchoalveolar lavage cultures in patients with VAP were previously isolated from subglottic secretions cultures in 85% of cases. No significant differences in outcome were found.

Conclusion

"The incidence of nosocomial pneumonia in mechanically ventilated patients can be significantly reduced by using a simple method that decreases the chronic microaspirations through the cuff of endotracheal tubes.”

View more clinical studies