TORNA ALL’ELENCO

Occurrence of ventilator associated pneumonia using tracheostomy tubes with subglottic secretion drainage in Critical Care

2017
AOU Città della Salute di Torino
ASL Città di Torino

Tipo pubblicazione

Conference Abstract

Autori/Collaboratori (9)Vedi tutti...

Terragni P

Brazzi L

Falco D


et alii...

Abstract

Introduction: Ventilator-Associated Pneumonia (VAP) represents a cause of morbidity and mortality in critically ill patients who require mechanical ventilation. Subglottic secretions above the endotracheal cuff are associated with bacteria colonization of lower respiratory tract, causing VAP. A preventive strategy to avoid subglottic secretions progression is to remove it by drainage with the use of special tracheal tubes effective in preventing both early onset and late onset VAP.[1] The purpose of this study is to measure VAP incidence in tracheostomized patients with suction above the cuff. Methods: Study design: matched cohort study with historical control in 3 academic italian ICUs. Procedures and measurements: upon admission to ICU, patients requiring mechanical ventilation were submitted to tracheostomy with a tracheal tube allowing drainage of subglottic secretions (treatment group) to reduce the incidence of VAP. A control group of tracheostomized patients without the ability of suctioning above the cuff was created applying the propensity score matching technique on a dataset including patients enrolled in the previous ELT study [2]. Primary endpoint: occurrence of post-tracheostomy VAP incidence (as determined by clinical pulmonary infection score) at 28-days from intubation. Secondary endpoints: 28-days mortality after tracheostomy; number of ventilator-free days and ICU-free days at 28-days from intubation; time of decannulation, total number of days of inpatient hospital stay; assessment of SOFA score. Results: 125 patients were enrolled in the treatment group from July 2014 to April 2016; 232 patients without suctioning were selected as a control group. Overall incidence of VAP was 10 patients (8%) in treatment group and 45 patients (19.4%) in the control group (p value = 0.004) with OR: 0.361 and CI (0.175; 0.745). In order to balance the two groups for timing of tracheostomy, gender, age, SAPS and SOFA covariates, a propensity score matching

DOI : 10.1186/s13054-017-1628-y

Keywords

adult; adverse device effect; artificial ventilation; bodily secretions; cohort analysis; controlled study; critically ill patient; endotracheal tube; female; gender; hospital patient; hospitalization; human; incidence; intubation; major clinical study; male; mortality; pneumatic cuff; propensity score; Sequential Organ Failure Assessment Score; statistical significance; study design; suction; tracheostomy tube; ventilator associated pneumonia;