A Randomized Clinical Trial of Continuous Aspiration of Subglottic Secretions in Cardiac Surgery Patients

Kollef, Marin H.; Skubas, Nikolaos J.; Sundt, Thoralf M.

doi:10.1378/chest.116.5.1339

Cited by 262 publications

(142 citation statements)

References 32 publications

Supporting

Mentioning

122

Contrasting

Unclassified

Order By: Relevance

“…The prevention of subglottic space secretions has been shown to reduce VAP [13][14][15]. The PU-cuffed ETTs implemented in our hospital are specifically designed to prevent the formation of cuff folds, thus preventing fluid and air leakage [9] and channeling of secretions from the oropharynx into the lungs.…”

Section: Discussionmentioning

confidence: 99%

Impact of a Low-Pressure Polyurethane Adult Endotracheal Tube on the Incidence of Ventilator-Associated Pneumonia: A before and after Concurrence Study

et al. 2013

View full text Add to dashboard Cite

Background. Ventilator-associated pneumonia (VAP) is a leading cause of morbidity and mortality in intensive care unit (ICU) patients, encompassing up to 15% of all hospital acquired infections. Our hospital implemented a facility-wide conversion from a low-volume high-pressure polyvinyl cuffed endotracheal tube (PV-cuffed ETT) to a high-volume low-pressure (HVLP) polyurethane-cuffed endotracheal tube (PU-cuffed ETT) in an effort to reduce the incidence of VAP. Methods. We completed an IRB approved, retrospective chart review comparing the number of episodes of VAP 12 months preceding and following the introduction of a new ETT. A diagnosis of VAP was made based upon the guidelines of our institution, consistent with the Center of Disease Control and Prevention definition. Results. The number of patients developing VAP the year after the ETT conversion reduced to 32 (16.3%) from 68 (24.7%) the year before the conversion ( = 0.028). The rate of VAP was reduced by 56% per ventilator day after the implementation of the PU-cuffed ETT ( < 0.001). No significant differences were observed in length of hospital stay, length of mechanical ventilation, or mortality before or after the conversion. Conclusions. We found that HVLP PU-cuffed ETTs were associated with a statistically significant reduction of VAP in the adult ICUs.

show abstract

Section: Discussionmentioning

confidence: 99%

Impact of a Low-Pressure Polyurethane Adult Endotracheal Tube on the Incidence of Ventilator-Associated Pneumonia: A before and after Concurrence Study

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Careful suctioning of secretion from the subglottic region of the intubated patient is an efficacious method of preventing VAP [4,9,10]. Kollef et al studied the influence of this procedure on VAP prophylaxis in cardiac surgery patients and observed that the time period before VAP onset was increased from 2.9 to 5.9 days [11]. A meta-analysis encompassing almost 2500 patients has recently demonstrated the efficiency of endotracheal tubes equipped with a system enabling the drainage of secretions from the subglottic region in providing VAP prophylaxis, shortening the ICU stay of the patient and reducing the number of days of assisted ventilation [12].…”

Section: Intubation and Mechanical Ventilationmentioning

confidence: 99%

Anaesthesiology and intensive care Possibilities of modification of risk factors for ventilator-associated pneumonia (VAP) in cardiac surgery patients

Wróblewska¹,

Stępniak²,

Burnos³

et al. 2013

kitp

View full text Add to dashboard Cite

StreszczeniePacjent poddawany operacji kardiochirurgicznej wymaga intensywnej opieki, której jakość może w dużym stopniu zminimalizować ryzyko wystąpienia powikłań pooperacyjnych w tej grupie chorych. Do czynników mających wpływ na zmniejszenie ryzyka respiratorowego zapalenia płuc (VAP) należy opieka nad pacjentem zaintubowanym i wentylowanym mechanicznie, utrzymywanie pacjenta w pozycji półleżącej z uniesieniem klatki piersiowej, żywienie enteralne, przeciwdziałanie kolonizacji jamy ustno-gardłowej oraz stosowanie sukralfatu zamiast antagonistów receptorów H2 w celu zobojętnienia kwasu żołądkowego w profilaktyce owrzodzeń stresowych żołądka. Tak jak w przypadku innych postaci zakażeń szpitalnych, podstawowym elementem zapobiegania VAP jest właści-wa higiena rąk personelu medycznego. Słowa kluczowe: intensywna opieka, kardiochirurgia, respiratorowe zapalenie płuc. Kardiochirurgia i Torakochirurgia Polska 2013; 10 (4) 389 ANAESTHESIOLOGY AND INTENSIVE CARE AbstractPatients undergoing cardiac surgery require intensive care, the quality of which may significantly reduce the risk of postoperative complications in this patient group. Factors which decrease the risk of ventilator-associated pneumonia (VAP) include care provided to intubated and mechanically ventilated patients, maintenance of a semirecumbent position with elevation of the chest, enteral feeding, prevention of oropharyngeal colonization, and the use of sucralfate instead of H2 receptor antagonists in the prophylaxis of stress ulcers of the stomach. Similarly to other forms of nosocomial infections, the main element of VAP prophylaxis is proper hand hygiene of healthcare workers.

show abstract

“…La presencia de colonización previa de la vía aérea se ha descrito en muchos estudios como factor de riesgo importante para el desarrollo posterior de neumonía temprana (7) e, inclusive, se han tratado de desarrollar técnicas para disminuir la carga de colonización y prevenir la infección (14)(15)(16). A pesar de que en nuestro estudio se encontró un alto índice de colonización, ésta no se encontró como factor de riesgo asociado a la aparición de neumonía.…”

Section: Factor De Riesgo P Ic95%unclassified

Factores de riesgo asociados a neumonía en pacientes

Yepes

Molina

Ortiz³

et al. 2009

biomedica

View full text Add to dashboard Cite

Introducción. La neumonía en los pacientes con trauma craneoencefálico es frecuente; a pesar de esto, hay pocos datos locales y no sabemos si su aparición afecta el pronóstico. Objetivo. Describir la incidencia y los hallazgos microbiológicos, y establecer los factores de riesgo asociados con la aparición de neumonía en los pacientes con trauma craneoencefálico grave. Materiales y métodos. Se realizó un estudio de cohorte, prospectivo, en el cual se incluyeron 39 pacientes con trauma craneoencefálico grave, con asistencia respiratoria mecánica y sin neumonía al ingreso.Este estudio se desarrolló durante 24 meses, tiempo en el cual se hizo seguimiento a una población con trauma craneoencefálico grave.Resultados. Se encontró un porcentaje de 80% de casos de neumonía, de los cuales, el 90% presentó neumonía temprana. El germen más frecuentemente encontrado fue Staphylococcus aureus, con 42,4%. En el análisis multivariado, sólo se encontró como factor de riesgo significativo la presencia de hipotensión y soporte vasopresor con un odds ratio (OR) de 27,9, IC95% 1,04-749,9, y p=0,047. No hubo diferencias significativas en los días de asistencia respiratoria mecánica o en la mortalidad entre los dos grupos. El factor de riesgo asociado a mortalidad en los pacientes con neumonía fue el puntaje bajo de la escala de coma de Glasgow al ingreso, con un OR de 2,19, IC95% 1,03-4,65, y p=0,04. Conclusión. La incidencia de neumonía en pacientes con trauma craneoencefálico grave es alta; a pesar de esto, su aparición no empeora el pronóstico. El único factor de riesgo encontrado que fue significativo, fue la presencia de hipotensión y soporte vasopresor.Palabras clave: neumonía, respiración artificial, traumatismos craneoencefálicos, infección hospitalaria, cuidados intensivos. Risk factors associated with the presence of pneumonia in patients with brain injuryIntroduction. Pneumonia in patients with head trauma occurs commonly; however, few data are available to evaluate the effects of the infection on the prognosis. Objective. The incidence and microbiological findings were described, and the associated risk factors were established with the appearance of pneumonia in patients with severe brain trauma. Materials and methods. A prospective cohort study was conducted that included 39 patients with severe brain trauma and who required mechanical ventilation; initially, none had pneumonia. These patients were observed during a 24-month period in an attempt to discern the principal risk factors associated with the onset of pneumonia.Results. Pneumonia occurred in 31 (80%) of the 39 patients, and 28 of these presented early pneumonia. The most frequent germ in patients with pneumonia was Staphylococcus aureus with a percentage of the 42.4%. In the multivariate analysis, the single statistically significant risk factor was the presence of hypotension and vasopressor support with a RR=27.9 (95% CI=1.0- 749.9, p<0.05). No significant differences in the days of mechanical ventilation or mortality in both groups. The major mortality-ass...

show abstract

A Randomized Clinical Trial of Continuous Aspiration of Subglottic Secretions in Cardiac Surgery Patients

Cited by 262 publications

References 32 publications

Impact of a Low-Pressure Polyurethane Adult Endotracheal Tube on the Incidence of Ventilator-Associated Pneumonia: A before and after Concurrence Study

Impact of a Low-Pressure Polyurethane Adult Endotracheal Tube on the Incidence of Ventilator-Associated Pneumonia: A before and after Concurrence Study

Anaesthesiology and intensive care Possibilities of modification of risk factors for ventilator-associated pneumonia (VAP) in cardiac surgery patients

Factores de riesgo asociados a neumonía en pacientes

Contact Info

Product

Resources

About