ORIGINAL ARTICLE   Free

Minerva Anestesiologica 2020 August;86(8):844-52

DOI: 10.23736/S0375-9393.20.13989-0

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Occurrence of ventilator associated pneumonia using a tracheostomy tube with subglottic secretion drainage

Pierpaolo TERRAGNI ¹ ✉, Rosario URBINO ², Franco MULAS ³, Laura PISTIDDA ³, Andrea P. COSSU ³, Davide PIREDDA ³, Chiara FAGGIANO ⁴, Davide FALCO ⁵, Giuseppina MAGNI ⁶, Luciana MASCIA ⁷, Claudia FILIPPINI ⁸, Vito Marco RANIERI ⁹

¹ Department of Anesthesiology and Intensive Care Medicine, University of Sassari, Sassari, Italy; ² Unit of Anesthesia and General Intensive Care, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy; ³ Unit of Anesthesia and General Intensive Care, University Hospital of Sassari, Sassari, Italy; ⁴ Unit of Anesthesia and General Intensive Care, Hospital of Chivasso, Chivasso, Turin, Italy; ⁵ University of Sassari, Sassari, Italy; ⁶ Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy; ⁷ Department of Anesthesiology and Intensive Care Medicine, Sapienza University, Rome, Italy; ⁸ University of Turin, Turin, Italy; ⁹ Department of Anesthesia and Intensive Care Medicine, Sant’Orsola Polyclinic, Alma Mater Studiorum University of Bologna, Bologna, Italy

BACKGROUND: Ventilator-associated pneumonia (VAP) is a significant cause of morbidity and mortality in critically ill patients who require mechanical ventilation (MV). Subglottic secretions above the endotracheal cuff are associated with bacteria colonization of lower respiratory tract, causing VAP. A preventive strategy to avoid subglottic secretion progression is the drainage with special tracheal tubes effective in preventing both early onset and late onset VAP. The purpose of this study was to measure VAP incidence in tracheostomized patients with suction above the cuff.
METHODS: The authors performed a matched cohort study with historical control in three academic Intensive Care Units (ICUs): upon ICU admission, patients requiring MV were submitted to tracheostomy with a tracheal tube allowing drainage of subglottic secretions (treatment group). A control group without suctioning above the cuff was selected applying the propensity score matching on dataset of previous ELT Study. VAP occurrence at 28-days from intubation was the primary endpoint; hospital mortality and ICU-free days at 28-days were the secondary endpoints.
RESULTS: Between July 2014 and April 2016, 125 tracheostomized patients were included in the analysis. 232 tracheostomized patients without suctioning were selected as a control group for the matched cohort study. The application of propensity score matching selected 60 patients to compare the two groups. Incidence of VAP was 8% in treatment group and 19.4% in the control group (P value =0.004). After balance with propensity score matching VAP was 8.3% and 21.7% (P value =0.0408), respectively.
CONCLUSIONS: Subglottic secretion drainage reduces incidence of VAP in critically ill patients requiring ongoing MV via tracheostomy.

KEY WORDS: Tracheostomy; Pneumonia, ventilator-associated; Ventilators, mechanical