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Prevention of Ventilator-Associated Pneumonia and Ventilator-Associated Conditions: A Randomized Controlled Trial With Subglottic Secretion Suctioning*

Damas, Pierre MD, PhD1; Frippiat, Frédéric MD, PhD2; Ancion, Arnaud MD2; Canivet, Jean-Luc MD, PhD1; Lambermont, Bernard MD, PhD2; Layios, Nathalie MD1; Massion, Paul MD, PhD1; Morimont, Philippe MD, PhD2; Nys, Monique PhD1; Piret, Sonia MD1; Lancellotti, Patrizio MD, PhD2; Wiesen, Patricia MD1; D’orio, Vincent MD, PhD3; Samalea, Nicolas1; Ledoux, Didier MD, PhD1

doi: 10.1097/CCM.0000000000000674
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Objectives: Ventilator-associated pneumonia diagnosis remains a debatable topic. New definitions of ventilator-associated conditions involving worsening oxygenation have been recently proposed to make surveillance of events possibly linked to ventilator-associated pneumonia as objective as possible. The objective of the study was to confirm the effect of subglottic secretion suctioning on ventilator-associated pneumonia prevalence and to assess its concomitant impact on ventilator-associated conditions and antibiotic use.

Design: Randomized controlled clinical trial conducted in five ICUs of the same hospital.

Patients: Three hundred fifty-two adult patients intubated with a tracheal tube allowing subglottic secretion suctioning were randomly assigned to undergo suctioning (n = 170, group 1) or not (n = 182, group 2).

Main Results: During ventilation, microbiologically confirmed ventilator-associated pneumonia occurred in 15 patients (8.8%) of group 1 and 32 patients (17.6%) of group 2 (p = 0.018). In terms of ventilatory days, ventilator-associated pneumonia rates were 9.6 of 1,000 ventilatory days and 19.8 of 1,000 ventilatory days, respectively (p = 0.0076). Ventilator-associated condition prevalence was 21.8% in group 1 and 22.5% in group 2 (p = 0.84). Among the 47 patients with ventilator-associated pneumonia, 25 (58.2%) experienced a ventilator-associated condition. Neither length of ICU stay nor mortality differed between groups; only ventilator-associated condition was associated with increased mortality. The total number of antibiotic days was 1,696 in group 1, representing 61.6% of the 2,754 ICU days, and 1,965 in group 2, representing 68.5% of the 2,868 ICU days (p < 0.0001).

Conclusions: Subglottic secretion suctioning resulted in a significant reduction of ventilator-associated pneumonia prevalence associated with a significant decrease in antibiotic use. By contrast, ventilator-associated condition occurrence did not differ between groups and appeared more related to other medical features than ventilator-associated pneumonia.

1Department of General Intensive Care, University Hospital of Liege, Liège, Belgium.

2Department of Medicine, University Hospital of Liege, Liège, Belgium.

3Department of Emergency Medicine, University Hospital of Liege, Liège, Belgium.

* See also p. 227.

This work was performed at University Hospital of Liege, Liège, Belgium.

Teleflex furnished the endotracheal tubes with subglottic secretion suctioning necessary for the whole study.

The authors have disclosed that they do not have any potential conflicts of interest.

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© 2015 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins