Subglottic suction frequency and adverse ventilator-associated events during critical illness

Abstract

Objective: Tracheal intubation and mechanical ventilation provide essential support for patients with respiratory failure, but the course of mechanical ventilation may be complicated by adverse ventilator-associated events (VAEs), which may or may not be associated with infection. We sought to understand how the frequency of subglottic suction, an indicator of the quantity of sputum produced by ventilated patients, relates to the onset of all VAEs and infection-associated VAEs. Design: We performed a case-crossover study including 87 patients with VAEs, and we evaluated 848 days in the pre-VAE period at risk for a VAE. Setting and participants: Critically ill patients were recruited from the medical intensive care unit of an academic medical center. Methods: We used the number of as-needed subglottic suctioning events performed per calendar day to quantify sputum production, and we compared the immediate pre-VAE period to the preceding period. We used CDC surveillance definitions for VAE and to categorize whether events were infection associated or not. Results: Sputum quantity measured by subglottic suction frequency is greater in the period immediately prior to VAE than in the preceding period. However, it does not discriminate well between infection-associated VAEs and VAEs without associated infection. Conclusions: Subglottic suction frequency may serve as a valuable marker of sputum quantity, and it is associated with risk of a VAE. However, our results require validation in a broader population of mechanically ventilated patients and intensive care settings.

The effect of a laughter-based intervention on airway patency in children with tracheostomy

“…In 2021, a study was conducted to investigate the suctioning frequency and ventilator-related side effects in acutely ill patients. The results of the mentioned research indicated that it is not possible to accurately check the quantity of airway secretions; But by counting the suctioning frequency performed, this amount can be estimated to some extent [33]. It seems that conducting more studies in the future with an intervention duration of more than 48 hours can better show the possible effect of laughter on reducing the number of suctions.…”

Application of a New Type of Protective Sputum Suction Device in Clinic against Cross-Infection between Medical Staff and Patients

“…Under mechanical ventilation, the patient's ability to spontaneously expectorate is weakened. So, sputum suction becomes an important task of airway management for patients with tracheal intubation or tracheotomy [ 5 , 6 ].…”

Comparison of the Effectiveness of Marked Suction Tubes vs. Plain Suction Tubes in Pediatric Mechanically Ventilated Patients

“…Nevertheless, this technique carries a risk of causing harm to the tracheal carina, a highly delicate region of the trachea with distinct sharp features. The stimulation caused by the suction tube elicits robust airway responses, resulting in repeated frictional irritation and consequently increasing the likelihood of damage, erosion, and bleeding of the airway mucosa [10]. Consequently, the 2010 guidelines of the American Association for Respiratory Care (AARC) advocate for the utilization of superficial suctioning as opposed to deep suctioning [11].…”