Occurrence of ventilator associated pneumonia using a tracheostomy tube with subglottic secretion drainage

Background: Ventilator-associated pneumonia (VAP) is a significant cause of morbidity and mortality in critically ill patients who require mechanical ventilation (MV). Subglottic secretions above the endotracheal cuff are associated with bacteria colonization of lower respiratory tract, causing VA P. A preventive strategy to avoid subglottic secretion progression is the drainage with special tracheal tubes effective in preventing both early onset and late onset VA P. The purpose of this study was to measure VA P incidence in tracheostomized patients with suction above the cuff. Methods: The authors performed a matched cohort study with historical control in three academic Intensive Care Units (ICUs): upon ICU admission, patients requiring MV were submitted to tracheostomy with a tracheal tube allowing drainage of subglottic secretions (treatment group). A control group without suctioning above the cuff was selected applying the propensity score matching on dataset of previous ELT Study. VA P occurrence at 28-days from intubation was the primary endpoint; hospital mortality and ICU-free days at 28-days were the secondary endpoints. Results: Between July 2014 and April 2016, 125 tracheostomized patients were included in the analysis. 232 tracheostomized patients without suctioning were selected as a control group for the matched cohort study. The application of propensity score matching selected 60 patients to compare the two groups. Incidence of VA P was 8% in treatment group and 19.4% in the control group (P value =0.004). After balance with propensity score matching VA P was 8.3% and 21.7% (P value =0.0408), respectively. Conclusions: Subglottic secretion drainage reduces incidence of VA P in critically ill patients requiring ongoing MV via tracheostomy.