Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 22 , ISSUE 1 ( 2018 ) > List of Articles

RESEARCH ARTICLE

Effect of continuous versus intermittent subglottic suctioning on tracheal mucosa by the mallinckrodt taperguard evac oral tracheal tube in intensive care unit ventilated patients: A prospective randomized study

Philippe Seguin, Harmonie Perrichet, Estelle Pabic, Yoann Launey, Marie Tiercin, Romain Corre, Graziella Brinchault, Bruno Laviolle

Keywords : Intensive care, intubation, mechanical ventilation, subglottic secretion drainage, tracheal injury

Citation Information : Seguin P, Perrichet H, Pabic E, Launey Y, Tiercin M, Corre R, Brinchault G, Laviolle B. Effect of continuous versus intermittent subglottic suctioning on tracheal mucosa by the mallinckrodt taperguard evac oral tracheal tube in intensive care unit ventilated patients: A prospective randomized study. Indian J Crit Care Med 2018; 22 (1):1-4.

DOI: 10.4103/ijccm.IJCCM_350_17

License: CC BY-ND 3.0

Published Online: 01-07-2008

Copyright Statement:  Copyright © 2018; The Author(s).


Abstract

Background and Aims: A risk of tracheal mucosa injury induced by subglottic suctioning has been raised. Therefore, this prospective randomized study aims to compare the effect of continuous suctioning of subglottic secretions versus intermittent suctioning of subglottic secretions (CSSS vs. ISSS) secretions on tracheal mucosa in front of the suctioning port of the endotracheal tube. Patients and Methods: Patients requiring intubation or reintubation in Intensive Care Unit with an expected ventilation duration > 24 h were eligible. Participants received CSSS at −20 mmHg or ISSS at −100 mmHg during 15 s and no suction during 8 s. The effect on tracheal mucosa in front of the suction port was assessed after intubation (T0) and before extubation (T1) using bronchoscopy. Tracheal mucosa damages were graded into five categories (no injury, erythema, edema, ulceration, or necrosis). The occurrence (no injury observed at T0 but present at T1) or the worsening (injury observed at T0 exacerbating at T1) was studied. Results: Seventy-three patients were included and 53 patients (CSSS, n = 26 and ISSS, n = 27) were evaluable on the primary endpoint. The occurrence or worsening of tracheal mucosal damages did not differ between the two groups (CSSS, n = 7 [27%] vs. ISSS, n = 5 [17%], P = 0.465). Daily average volume of suctioned secretion was higher with ISSS (74 ± 100 ml vs. 20 ± 25 ml, P < 0.001). Impossibility to aspirate was higher with CSSS (0.14 ± 0.16 per day vs. 0.03 ± 0.07 per day, P < 0.001). Conclusions: Our results suggest that tracheal mucosal damages did not differ between CSSS and ISSS. The aspirated volume was higher and impossibility to aspirate was lower with ISSS. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT01555229.


PDF Share
  1. Damas P, Frippiat F, Ancion A, Canivet JL, Lambermont B, Layios N, et al. Prevention of ventilator-associated pneumonia and ventilator-associated conditions: A randomized controlled trial with subglottic secretion suctioning. Crit Care Med 2015;43:22-30.
  2. Muscedere J, Rewa O, McKechnie K, Jiang X, Laporta D, Heyland DK, et al. Subglottic secretion drainage for the prevention of ventilator-associated pneumonia: A systematic review and meta-analysis. Crit Care Med 2011;39:1985-91.
  3. Lacherade JC, De Jonghe B, Guezennec P, Debbat K, Hayon J, Monsel A, et al. Intermittent subglottic secretion drainage and ventilator-associated pneumonia: A multicenter trial. Am J Respir Crit Care Med 2010;182:910-7.
  4. Berra L, De Marchi L, Panigada M, Yu ZX, Baccarelli A, Kolobow T, et al. Evaluation of continuous aspiration of subglottic secretion in an in vivo study. Crit Care Med 2004;32:2071-8.
  5. Girou E, Buu-Hoi A, Stephan F, Novara A, Gutmann L, Safar M, et al. Airway colonisation in long-term mechanically ventilated patients. Effect of semi-recumbent position and continuous subglottic suctioning. Intensive Care Med 2004;30:225-33.
  6. Dragoumanis CK, Vretzakis GI, Papaioannou VE, Didilis VN, Vogiatzaki TD, Pneumatikos IA, et al. Investigating the failure to aspirate subglottic secretions with the Evac endotracheal tube. Anesth Analg 2007;105:1083-5.
  7. Harvey RC, Miller P, Lee JA, Bowton DL, MacGregor DA. Potential mucosal injury related to continuous aspiration of subglottic secretion device. Anesthesiology 2007;107:666-9.
  8. Spapen H, Suys E, Nieboer K, Stiers W, De Regt J. Automated intermittent aspiration of subglottic secretions and tracheal mucosa damage. Minerva Anestesiol 2013;79:316-7.
  9. Rello J, Soñora R, Jubert P, Artigas A, Rué M, Vallés J, et al. Pneumonia in intubated patients: Role of respiratory airway care. Am J Respir Crit Care Med 1996;154:111-5.
  10. Bouza E, Pérez MJ, Muñoz P, Rincón C, Barrio JM, Hortal J, et al. Continuous aspiration of subglottic secretions in the prevention of ventilator-associated pneumonia in the postoperative period of major heart surgery. Chest 2008;134:938-46.
  11. Smulders K, van der Hoeven H, Weers-Pothoff I, Vandenbroucke-Grauls C. A randomized clinical trial of intermittent subglottic secretion drainage in patients receiving mechanical ventilation. Chest 2002;121:858-62.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.