Emmanuelle Girou1, Annie Buu-Hoi2, François Stephan3, Ana Novara4, Laurent Gutmann2, Michel Safar5, Jean-Yves Fagon4. 1. Infection Control Unit, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris , 51 avenue Mal de Lattre de Tassigny, 94010, Créteil, France. emmanuelle.girou@hmn.ap-hop-paris.fr. 2. Department of Microbiology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 20-40 rue Leblanc, 75015, Paris, France. 3. Department of Anesthesiology, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, 51 avenue Mal de Lattre de Tassigny, 94010, Créteil, France. 4. Medical Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 20-40 rue Leblanc, 75015, Paris, France. 5. Department of Internal Medicine, Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, 1 place du Parvis Notre Dame, 75004, Paris, France.
Abstract
OBJECTIVE: To evaluate the impact of continuous subglottic suctioning and semi-recumbent body position on bacterial colonisation of the lower respiratory tract. DESIGN: A randomised controlled trial. SETTING: The ten-bed medical ICU of a French university hospital. PATIENTS: Critically ill patients expected to require mechanical ventilation for more than 5 days. INTERVENTIONS: Patients were randomly assigned to receive either continuous suctioning of subglottic secretions and semi-recumbent body position or to receive standard care and supine position. MEASUREMENTS AND RESULTS:Oropharyngeal and tracheal secretions were sampled daily and quantitatively cultured. All included patients were followed up from day 1 (intubation) to day 10, extubation or death. Ninety-seven samples of oropharynx and trachea were analysed (40 for the suctioning group and 57 for the control group). The median bacterial counts in trachea were 6.6 Log10 CFU/ml (interquartile range, IQR, 4.4-8.3) in patients who received continuous suctioning and 5.1 Log10 CFU/ml (IQR 3.6-5.5) in control patients. Most of the patients were colonised in the trachea after 1 day of mechanical ventilation (75% in the suctioning group, 80% in the control group). No significant difference was found in the daily bacterial counts in the oropharynx and in the trachea between the two groups of patients. CONCLUSION:Tracheal colonisation in long-term mechanically ventilated ICU patients was not modified by the use of continuous subglottic suctioning and semi-recumbent body position.
RCT Entities:
OBJECTIVE: To evaluate the impact of continuous subglottic suctioning and semi-recumbent body position on bacterial colonisation of the lower respiratory tract. DESIGN: A randomised controlled trial. SETTING: The ten-bed medical ICU of a French university hospital. PATIENTS: Critically illpatients expected to require mechanical ventilation for more than 5 days. INTERVENTIONS:Patients were randomly assigned to receive either continuous suctioning of subglottic secretions and semi-recumbent body position or to receive standard care and supine position. MEASUREMENTS AND RESULTS: Oropharyngeal and tracheal secretions were sampled daily and quantitatively cultured. All included patients were followed up from day 1 (intubation) to day 10, extubation or death. Ninety-seven samples of oropharynx and trachea were analysed (40 for the suctioning group and 57 for the control group). The median bacterial counts in trachea were 6.6 Log10 CFU/ml (interquartile range, IQR, 4.4-8.3) in patients who received continuous suctioning and 5.1 Log10 CFU/ml (IQR 3.6-5.5) in control patients. Most of the patients were colonised in the trachea after 1 day of mechanical ventilation (75% in the suctioning group, 80% in the control group). No significant difference was found in the daily bacterial counts in the oropharynx and in the trachea between the two groups of patients. CONCLUSION: Tracheal colonisation in long-term mechanically ventilated ICU patients was not modified by the use of continuous subglottic suctioning and semi-recumbent body position.
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