Subglottic Secretion Aspiration in the Prevention of Ventilator-Associated Pneumonia

Scherzer, Rachel

doi:10.1097/dcc.0b013e3181f0bfd1

Cited by 6 publications

(5 citation statements)

References 10 publications

(9 reference statements)

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“…This means that to ensure proper practice, innovative techniques such as electronic and mechanical alarms have to be implemented, as do educational measures. 20,32,[48][49][50] Better strategies should be adopted at the bedside to eliminate erroneous behavior and attitudes. On the other hand, the implementation of some practices, such as subglottic suctioning of respiratory secretions or selective digestive decontamination, does not depend on personal knowledge or conviction, but on unit or hospital policies.…”

Section: Discussionmentioning

confidence: 99%

Prevention of Ventilator-Associated Pneumonia: Can Knowledge and Clinical Practice Be Simply Assessed in a Large Institution?

Pérez‐Granda

Muñóz

Heras³

et al. 2012

Respir Care

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OBJECTIVE: User-friendly scores to assess knowledge of guidelines for prevention of ventilatorassociated pneumonia (VAP) are scarce and have mainly evaluated nurses, but not students or physicians. Gaps between knowledge and actual clinical practice have not been sufficiently analyzed. We assessed knowledge of and adherence to guidelines for prevention of VAP among physicians, nurses, and students in adult ICUs. METHODS: All adult ICU healthcare workers were invited to complete a 20-point questionnaire. The first part assessed personal knowledge of international guidelines for prevention of VAP; the second part assessed daily clinical practice. Personal knowledge and daily practice were scored from 0 to 10 points. RESULTS: We invited 257 ICU healthcare workers to participate in the study, and 167 (65%) accepted (32/54 physicians, 108/176 nurses, and 27/27 students). The median (IQR) personal knowledge scores for physicians, nurses, and students were 6 (5-7), 5 (4 -6), and 5 (4 -7), respectively. The median scores for daily clinical practice for physicians and nurses were 5 (4 -6) and 4 (3-5), respectively. Healthcare workers with more than 1 year of ICU experience scored significantly better in personal knowledge than those with less experience: 6 (5-7) versus 4 (3-6), P ‫؍‬ .004. CONCLUSIONS: A simple, easy-to-complete questionnaire enabled us to rapidly evaluate personal knowledge and reported clinical practice in prevention of VAP in large teaching institutions. These scores will be used as baseline figures to assess the impact of educational and intervention campaigns.

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Section: Discussionmentioning

confidence: 99%

Prevention of Ventilator-Associated Pneumonia: Can Knowledge and Clinical Practice Be Simply Assessed in a Large Institution?

Pérez‐Granda

Muñóz

Heras³

et al. 2012

Respir Care

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“…Importantly, the second CSS includes design features to ensure that the tip of the catheter is completely clean after it is removed from the trachea. This tip cleaning feature may reduce the risk of introducing secretions into the trachea and lungs, thus also diminishing the risk of ventilator-associated pneumonia [12], [13], [14], and by maintaining a more patent airway compared to a CSS without this feature, worsening of obesity-related breathing difficulties to the point of developing MOHS [10].…”

Section: Discussionmentioning

confidence: 99%

Significance of a clean-tip catheter closed suctioning system in a high-setting ventilated, super morbidly obese patient with profuse respiratory secretions

Mazlan

Zaini

Hassan

et al. 2017

Respiratory Medicine Case Reports

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IntroductionClosed suctioning is commonly used in the context of high-setting mechanical ventilation (MV), given its ability to prevent lung volume loss that otherwise accompanies open suctioning. However, closed suctioning systems (CSS) are not equivalent regarding components and capabilities, and thus this technique may be differentially effective to adequately clear patient secretions from an endotracheal tube (ETT), which is of paramount importance when the tube size makes the ETT particularly vulnerable to block by patient secretions.Case presentationA 25-year-old super morbidly obese female (body mass index = 55 kg/meter2) presented with worsening shortness of breath. For MV, pairing of a 6 mm (mm) diameter ETT to accommodate the patient's vocal cord edema, with a CSS not designed to maintain a clean catheter tip, precipitated ETT blockage and respiratory acidosis. Replacement of these devices with a 6.5 mm ETT and a CSS designed to keep the catheter tip clean resolved the complications. After use of the different ETT and CSS for approximately one week, the patient was discharged to home.DiscussionThe clean-tip catheter CSS enabled a more patent airway than its counterpart device that did not have this feature. Use of a clean-tip catheter CSS was an important care development for this patient, because this individual's super morbidly obese condition minimized tolerance for MV complications that would exacerbate her pre-existing tenuous respiratory health status.ConclusionSpecial attention should be given to the choices of ETT size and CSS to manage super morbidly obese patients who have a history of difficult airway access.

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“…Dezfulian et al [36], only found a positive association for early-onset VAP in patients requiring more than 72 h of mechanical ventilation; Muscedere et al [37] demonstrated a 50% reduction of VAP with this preventive measure; furthermore, the patients that eventually developed VAP had delayed onset pneumonia. Mortality, mechanical ventilation, and ICU duration were not affected by its implementation [37][38][39]. It is important to highlight the need for strict "cuff pressure control" to ensure effective drainage.…”

Section: Subglottic Secretions Drainagementioning

confidence: 99%

Can We Achieve Zero Hospital-Acquired Pneumonia?

Alves

Peña-López

Rojas

et al. 2018

Curr Treat Options Infect Dis

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Purpose of Review Ventilator-associated pneumonia (VAP) is still a common complication in intensive care units, being associated with higher costs, increasing hospital length of stay, duration of mechanical ventilation and use of antimicrobials. Ventilator care bundles are key measures to patient care quality improvement, and their implementation contributes to the reduction in the incidence of VAP. The current review focuses on preventive measures of VAP and a potential concept of zero VAP rate. Recent Findings Several reports have documented a decrease in VAP rate with the implementation of ventilator care bundles. Despite the improvement on VAP incidence, risk factors to VAP are numerous and although some are preventable, it is unachievable to eliminate the majority. Summary VAP is not always preventable and thus unlikely to reach zero rate. Several reports have documented a decrease in the incidence of VAP when a bundle is implemented. The major restrain to care bundles implementation is adherence; compliance to them is the achieving goal that can be reached by the use of a maximum of five interventions, with a strong effort on multidisciplinary education and continued feedback. Surveillance, prevention, and education remain a priority in critical care in order to minimize VAP.

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Subglottic Secretion Aspiration in the Prevention of Ventilator-Associated Pneumonia

Cited by 6 publications

References 10 publications

Prevention of Ventilator-Associated Pneumonia: Can Knowledge and Clinical Practice Be Simply Assessed in a Large Institution?

Prevention of Ventilator-Associated Pneumonia: Can Knowledge and Clinical Practice Be Simply Assessed in a Large Institution?

Significance of a clean-tip catheter closed suctioning system in a high-setting ventilated, super morbidly obese patient with profuse respiratory secretions

Can We Achieve Zero Hospital-Acquired Pneumonia?

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