Subglottic secretion drainage for preventing ventilator associated pneumonia: A meta-analysis

Endotracheal Tubes: Old and NewDiscussion

“…When only including studies that enrolled subjects expected to require (Table 2). [139][140][141][142] Regardless of the combination of the studies included in the analysis, the results suggest that SSD results in a reduction of VAP by ϳ50% and may be associated with reduced early onset of VAP, shorter duration of mechanical ventilation, and fewer days in the ICU, but not a reduced mortality.…”

“…Another study using continuous aspiration of subglottic secretions reported a 40% incidence of postextubation laryngeal edema and considered it an adverse outcome of SSD. 133 These issues have not been reported using intermittent SSD, and given that the intermittent method appears to affect VAP similarly as continuous aspiration, 140 intermittent SSD may be preferred.…”

Prevention of Ventilation Associated Pneumonia, New Ideas and Better Results

“…On the other hand, Bo et al [34], Wang et al [35] and Dezfulian et al [36], published papers show that there is no statistical significant in late onset VAP. Wang et al reveals that SSD significantly reduced early onset VAP (RR=0.23, 95% CI:0.13-0.43, p<0.00001), while late onset of VAP (RR=1.15, 95% CI: 0.51-2.61, p<0.73) [35], Dezfulian suggests that SSD is ineffective in preventing late onset VAP because P. aeruginosa and other Gram negative bacilli, can colonize the trachea without first appearing in the oropharyngeal or subglottic secretions, possibly through adhesion to endotracheal tube biofilm, that indicate that microaspiration may be less relevant to the pathogenesis of pneumonia with these organisms [36]. On the other hand Bo et al [34] proves that there is a decrease in the incidence of VAP with SSD (P<0.05) and indicates that the efficacy is due to significant reduction caused by Gram-positive cocci and Haemophilus influenzae organisms.…”

“…The effect of SSD is further than decreasing the VAP incidence; there is a significant shorten of the mechanical ventilation (by 1.55 days), and delayed the onset of VAP [35], stay in the ICU (about 3 days) for patient with SSD [36,38], Those effects are reflected on the cost as well, despite the use of SSD tube costs $14 more than usual ETT, SSD saves around $4,000 saved per case [39].…”

“…The optimal suction pressure is between 20 and 30 mmHg but the clinical variation should be considered, those pressures are sufficient to keep the suction efficient in removing the subglottic secretion specially when there is a viscoid secretion [40], the suction may be continuous or intermittent, it has been proved that both continuous and intermittent has the same effects in the prevention of VAP [35,36], the continuous suction has problems with the mucosa causing herniation of the of the tracheal mucosa into the suction part leading to block of the suction system especially with high suction pressure [41]. While the intermittent suction is better in the mucosal injury, although in the time between the suctions, there may be some leakage between the folds of the cuff and the tracheal causing late onset VAP.…”