Comparison of suction above cuff and standard endotracheal tubes in neurological patients for the incidence of ventilator-associated pneumonia and in-hospital outcome: A randomized controlled pilot study

Abstract

Background:Ventilator-associated pneumonia (VAP) is a common complication with endotracheal intubation. The occurrence of VAP results in significant mortality and morbidity. Earlier studies have shown reduction in the incidence of VAP with subglottic secretion drainage. The incidence of VAP in neurologically injured patients is higher and can impact the neurological outcome. This study aimed to compare the incidence of VAP with standard endotracheal tube (SETT) and suction above cuff endotracheal tube (SACETT) in neurologically ill patients and its impact on clinical outcome.Methods:Fifty-four patients with neurological illnesses aged ≥18 years and requiring intubation and/or ventilation and anticipated to remain on ETT for ≥48 h were randomized to receive either SETT or SACETT. All the VAP preventive measures were similar between two groups except for the difference in type of tube.Results:The data of 50 patients were analyzed. The incidence of clinical VAP was 20% in SETT group and 12% in SACETT group; (P = 0.70). The incidence of microbiological VAP was higher in the SETT group (52%) as compared to SACETT group (44%) but not statistically significant; (P = 0.78). There was no difference between the two groups for measured outcomes such as duration of intubation, mechanical ventilation, and Intensive Care Unit stay.Conclusions:In this pilot study in neurological population, a there was no significant difference in incidence of clinical and microbiological VAP was seen between SETT and SACETT, when other strategies for VAP prevention were similar. Other outcomes were similar with use of either tube for intubation.

Investigating the Role of Subglottic Secretions Suctioning in the Prevention of ‎Ventilator Associated Pneumonia in Patients With Invasive Mechanical ‎Ventilation

“…Also Jena et al, pilot study aiming to compare the incidence of VAP with standard ETT and suction above the cuff tube in neurologically ill patients and its impact on clinical outcome. In this study there was no significant difference in incidence of clinical and microbiological VAP seen between standard ETT and the one with SSS when other strategies for prevention of VAP were similar (Jena et al, 2016).…”

Suction Above Cuff Endotracheal Tube Can Reduce Ventilator-Associated Pneumonia in COVID-19 Patients

“…According to the Yuzkat and Demir studies [4], the use of SACETT reduces the incidence of PIV as well as the incidence of agitation, sore throat, and difficulty swallowing. The advantage of SACETT over the standard endotracheal tube is also shown in studies by other authors, including Jena et al [5]. In turn, Kelley et al [6] calculated that it is necessary to use tubes with suction above the cuff in 33 patients to prevent one episode of VAP, which shows that this protocol would be cost effective.…”

Pathogenesis-Targeted Preventive Strategies for Multidrug Resistant Ventilator-Associated Pneumonia: A Narrative Review

“…These results were corroborated by a further RCT which linked subglottic secretions suctioning to a significant reduction in VAP prevalence and in antibiotic consumption [ 52 ]. Several further studies and a very recent meta-analysis led to similar results [ 53 , 54 , 55 , 56 ]; however, some failed to show a decrease in clinical and microbiological VAP incidence, maybe due to small sample sizes [ 57 , 58 , 59 ]. Some authors have also questioned what the proper modality should be, even in terms of timing or system design.…”