Effect of Perioperative Subglottic Secretion Drainage on Ventilator-Associated Pneumonia After Cardiac Surgery: A Retrospective, Before-and-After Study

Hygiene auf der Intensivstation – Minimierung nosokomialer Infektionen

“…Nun konnten in einer neueren Metaanalyse eine Reduktion der VAP-Rate und eine Reduktion der Sterblichkeit ermittelt werden, allerdings ohne eine Reduktion der Aufenthaltsdauer auf der Intensivstation oder im Krankenhaus [19]. In einer retrospektiven Studie mit Anwendung der kontinuierlichen Absaugung während der Operation und intermittierend nach Operation wurde bei kardiochirurgischen Patienten eine Reduktion der VAP-Rate beobachtet [20].…”

Response to Society for Healthcare Epidemiology (SHEA) recommendations for ventilator-associated pneumonia (VAP)

“…4 Further, routine use of SSD may reduce the risk of postoperative VAP in patients undergoing cardiac surgery, with those undergoing intraoperative continuous and postoperative intermittent SSD reporting a 70% reduction in the rate of postoperative VAP. 5 Although these findings are very promising, they were not considered when reclassifying SSD recommendations in the new guidelines. Studies that have evaluated reductions in the duration of mechanical ventilation with SSD are limited to patients expected to require >48-72 hours of mechanical ventilation.…”

“…4 Furthermore, some patients with chronic central lines, such as those on total parenteral nutrition for shortbowel syndrome, may have unmodifiable risk factors for recurrent bloodstream infections that will repeatedly contribute to CLABSI rates, even with aggressive prevention strategies. 5 As central-line care optimizes over time, more difficult-to-prevent CLABSIs, such as those identified with the dCLABSI and EOL-CLABSI subgroups, will start to overshadow pCLABSIs, making it increasingly difficult to demonstrate the importance of infection prevention or observe statistical differences when studying novel prevention techniques. 6 Additionally, frontline clinical staff, such as bedside nurses, may feel significant pressure from leadership each time a CLABSI occurs, when a proportion of CLABSIs may not actually be preventable.…”

How healthcare must respond to ventilator-associated pneumonia (VAP) in invasively mechanically ventilated COVID-19 patients

“…Additionally, outside of critical care settings, SSETs have also demonstrated reductions in VAP risk during short-term intraoperative intubations. Nam et al demonstrated that routine subglottic secretion drainage in patients undergoing cardiac surgery led to 600% reduction in postoperative VAP incidence [ 7 ]. Yuzkat et al showed that endotracheal tubes with SSETs in rhinoplasty reduced the incidence of postoperative respiratory complications as well as the incidence of VAP, agitation, sore throat and swallowing difficulty [ 8 ].…”