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Minerva Anestesiologica 2020 May 22

DOI: 10.23736/S0375-9393.20.13989-0


lingua: Inglese

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 M. RANIERI 9

1 Anesthesiology and Intensive Care Medicine, University of Sassari, Sassari, Italy; 2 Anesthesia and General Intensive Care Unit, Città della Salute e della Scienza di Torino, Turin, Italy; 3 Anesthesia and General Intensive Care Unit, AOU Sassari, Sassari, Italy: 4 Anesthesia and General Intensive Care Unit, Ospedale Civico di Chivasso, Chivasso, Turin, Italy; 5 University of Sassari, Sassari, Italy; 6 Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy; 7 Anesthesiology and Intensive Care Medicine, Sapienza University of Rome, Rome, Italy; 8 University of Turin, Turin, Italy; 9 Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, 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: Study design - matched cohort study with historical control in three academic 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

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