P Combes1, B Fauvage, C Oleyer. 1. Département d'Information Médicale et de Santé Publique, Centre Hospitalier de Roanne, France.
Abstract
OBJECTIVE: To compare the ventilator-associated pneumonia (VAP) incidence rates in mechanically ventilated patients according to the type of endotracheal suctioning (closed versus open). SETTING: The Neurosurgery Intensive Care Unit of the Grenoble University Hospital, France. DESIGN: A prospective randomised study performed after a 6-month period of nursing personnel training. PATIENTS: One hundred four consecutive patients needing mechanical ventilation for more than 48 h were randomised into two groups. To be eligible, patients had to have no active infection or respiratory affection in their passes. In the Stericath group (S+, n = 54), patients were not disconnected from the ventilator during suctioning. The others were routinely managed (S-, n = 50). In both groups patterns of frequency and duration of suctioning were performed according to a standardised protocol. MEASUREMENTS: The non-adjusted incidence rate of VAP was lower for S+ than for S- (7.32 versus 15.89 per 1000 patient-days, p = 0.07). Multivariate analysis performed using the Cox model showed an adjusted risk of VAP 3.5 times higher in S- (95% CI: 11.00-12.33). The risk being 4.3 higher in patients receiving gastric acid secretion inhibitors (1.08-16.82). In non-censored cases (n = 76) length of ICU stay increased by an average of 16.8 days when VAP was present (p = 0.0008). No adverse effect due to Stericath use was noted and volume of tracheal aspirate was similar between groups (p = 0.178). CONCLUSION: The use of Stericath reduced the incidence rate of VAP without demonstrating any adverse effect.
RCT Entities:
OBJECTIVE: To compare the ventilator-associated pneumonia (VAP) incidence rates in mechanically ventilated patients according to the type of endotracheal suctioning (closed versus open). SETTING: The Neurosurgery Intensive Care Unit of the Grenoble University Hospital, France. DESIGN: A prospective randomised study performed after a 6-month period of nursing personnel training. PATIENTS: One hundred four consecutive patients needing mechanical ventilation for more than 48 h were randomised into two groups. To be eligible, patients had to have no active infection or respiratory affection in their passes. In the Stericath group (S+, n = 54), patients were not disconnected from the ventilator during suctioning. The others were routinely managed (S-, n = 50). In both groups patterns of frequency and duration of suctioning were performed according to a standardised protocol. MEASUREMENTS: The non-adjusted incidence rate of VAP was lower for S+ than for S- (7.32 versus 15.89 per 1000 patient-days, p = 0.07). Multivariate analysis performed using the Cox model showed an adjusted risk of VAP 3.5 times higher in S- (95% CI: 11.00-12.33). The risk being 4.3 higher in patients receiving gastric acid secretion inhibitors (1.08-16.82). In non-censored cases (n = 76) length of ICU stay increased by an average of 16.8 days when VAP was present (p = 0.0008). No adverse effect due to Stericath use was noted and volume of tracheal aspirate was similar between groups (p = 0.178). CONCLUSION: The use of Stericath reduced the incidence rate of VAP without demonstrating any adverse effect.
Authors: Tom J Overend; Cathy M Anderson; Dina Brooks; Lisa Cicutto; Michael Keim; Debra McAuslan; Mika Nonoyama Journal: Can Respir J Date: 2009 May-Jun Impact factor: 2.409
Authors: Leonardo Lorente; María Lecuona; Alejandro Jiménez; María L Mora; Antonio Sierra Journal: Intensive Care Med Date: 2006-03-02 Impact factor: 17.440