Effect of continuous oral suctioning on the development of ventilator-associated pneumonia: A pilot randomized controlled trial

Chow, Meyrick C.M.; Kwok, Shu-man; Luk, H.K.Y.; Law, Jenny W.H.; Leung, Bartholomew P.K.

doi:10.1016/j.ijnurstu.2012.06.003

Cited by 19 publications

(16 citation statements)

References 37 publications

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“…VAP reduction and shorter MV duration were noted when oral suctioning was done immediately prior to turning patients (Chang, Tsai, & Lin, ; Chao, Chen, Wang, Lee, & Tsai, ) . Similar findings were noted when continuous oral suctioning with a saliva ejector (similar to devices used in dental offices) was initiated (Chow, Kwok, Luk, Law, & Leung, ). Cutler and Sluman () implemented a comprehensive oral care bundle that included oropharyngeal suction prior to turning and reported a 0.53 risk reduction in a historical control study.…”

Section: Introductionsupporting

confidence: 69%

Impact of deep oropharyngeal suctioning on microaspiration, ventilator events, and clinical outcomes: A randomized clinical trial

Sole

Talbert

Yan

et al. 2019

Journal of Advanced Nursing

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Aims To evaluate a deep oropharyngeal suction intervention (NO‐ASPIRATE) in intubated patients on microaspiration, ventilator‐associated events and clinical outcomes. Design Prospective, two‐group, single‐blind, randomized clinical trial. Methods The study was conducted between 2014 ‐ 2017 in 513 participants enroled within 24 hr of intubation and randomized into NO‐ASPIRATE or usual care groups. Standard oral care was provided to all participants every 4 hr and deep oropharyngeal suctioning was added to the NO‐ASPIRATE group. Oral and tracheal specimens were obtained to quantify α‐amylase as an aspiration biomarker. Results Data were analysed for 410 study completers enrolled at least 36 hr: NO‐ASPIRATE (N = 206) and usual care (N = 204). Percent of tracheal specimens positive for α‐amylase, mean tracheal α‐amylase levels over time and ventilator‐associated events were not different between groups. The NO‐ASPIRATE group had a shorter hospital length of stay and a subgroup with moderate aspiration at baseline had significantly lower α‐amylase levels across time. Conclusion Hospital length of stay was shorter in the NO‐ASPIRATE group and a subgroup of intervention participants had lower α‐amylase across time. Delivery of standardized oral care to all participants may have been an intervention itself and possibly associated with the lack of significant findings for most outcomes. Impact This trial compared usual care to oral care with a deep suctioning intervention on microaspiration and ventilator‐associated events, as this has not been systematically studied. Further research on the usefulness of α‐amylase as an aspiration biomarker and the role of oral suctioning, especially for certain populations, is indicated. Trial registration number: ClinicalTrials.gov: NCT02284178.

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Section: Introductionsupporting

confidence: 69%

Impact of deep oropharyngeal suctioning on microaspiration, ventilator events, and clinical outcomes: A randomized clinical trial

Sole

Talbert

Yan

et al. 2019

Journal of Advanced Nursing

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“…29 A local study showed that continuous clearance of oral secretion by the saliva ejector might reduce the rate of VAP, decreasing the duration of mechanical ventilation, and shortening the duration of stay of patients in the ICU. 30 Although gastroesophageal aspiration is implicated in VAP development, in an intention-to-treat study of 449 patients on mechanical ventilation, the absence of gastric volume monitoring was not inferior to routine residual gastric volume monitoring in terms Hong Kong Med J ⎥ Volume 21 Number 1 ⎥ February 2015 ⎥ www.hkmj.org of development of VAP (16.7% in the intervention group and 15.8% in the control group), nor were there any significant between-group differences in other ICU-acquired infections, mechanical ventilation duration, ICU stay duration, or mortality. 31 There were more VAPs with early enteral feeding, and less with post-pyloric feeding.…”

Section: Oral and Gastro-intestinal Tractmentioning

confidence: 99%

Prevention of ventilator-associated pneumonia

Lau

Tang

et al. 2015

Hong Kong Med J

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“…The reduction may be due to the oropharyngeal suctioning procedure. [17][18][19] The suction catheter may be more effective than is the suction swab commonly used at our medical center for removal of oral secretions.…”

Section: Discussionmentioning

confidence: 99%

Pepsin and Amylase in Oral and Tracheal Secretions: A Pilot Study

Sole¹,

Conrad²,

Bennett³

et al. 2014

American Journal of Critical Care

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worth, RN, MSN, CCRN, CCNS, and Devendra Indulal Mehta, MBBS, MSc(dist), MRCP Background Endotracheal intubation increases the risk for microaspiration of secretions around the tube cuff. Pepsin has been used as a biomarker for gastric aspiration. Amylase is a newer proposed biomarker for aspiration of oral contents. Objective To assess the presence of pepsin and amylase in paired oral-tracheal secretions of adult patients treated with mechanical ventilation. Methods In this descriptive study, paired samples of oral and tracheal secretions were obtained from adult patients at baseline and again within 4 hours when a need for endotracheal suctioning was assessed. Assays of pepsin and amylase were processed in a specialty diagnostic laboratory. Results The sample consisted of 10 men and 3 women with a median age of 56 years. The majority were intubated with a subglottic suction endotracheal tube (9 patients, 69%), receiving synchronized intermittent mandatory ventilation (10 patients; 77%), and receiving enteral feedings (11 patients; 85%) through a tube distally placed in the stomach (8 patients; 67%). Pepsin was present in oral secretions of 9 patients (69%), and in tracheal specimens of 7 patients (54%) at one or both sampling times. Amylase was detected in all patients' oral secretions and in tracheal secretions of 5 patients (38%) at one or both sampling times. Conclusions Many patients had pepsin, amylase, or both in tracheal aspirates. Pepsin was more commonly detected than was amylase. Although the relationship of this finding to longterm outcomes was not assessed, findings indicate that microaspiration of oral and gastric secretions occurs frequently.

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Effect of continuous oral suctioning on the development of ventilator-associated pneumonia: A pilot randomized controlled trial

Cited by 19 publications

References 37 publications

Impact of deep oropharyngeal suctioning on microaspiration, ventilator events, and clinical outcomes: A randomized clinical trial

Impact of deep oropharyngeal suctioning on microaspiration, ventilator events, and clinical outcomes: A randomized clinical trial

Prevention of ventilator-associated pneumonia

Pepsin and Amylase in Oral and Tracheal Secretions: A Pilot Study

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