Objective: To assess the influence of the subglottic secretion drainage on the morbidity of ventilator associated pneumonia in mechanically ventilated patients.
Methods: All cases requiring intubation in SICU were intubated with a special type endotracheal tube which has a small-bore cannula in its wall for subglottic secretion drainage. They were randomly divided into two groups received subglottic secretion drainage(SSD) and usual care(NON-SSD) respectively. Bacterial culture of samples from the oropharynx, subglottic secretions and lower respiratory tract were obtained periodically. The amount of subglottic secretion aspirated daily, ventilated days and the number of cases with VAP were recorded. Etiologic diagnosis of VAP was based on the quantitative bacterial culture of secretions obtained by protected specimen brush(PSB).
Results: The morbidity of VAP in the SSD group (n = 35) (23%) was lower than that in the NON-SSD group (n = 33) (45%) (P < 0.05). The difference was due to the significant reduction of VAP caused by gram-positive cocci and Haemophilus influenzae organisms. However, no difference was observed in the incidence of VAP caused by non-fermental bacteria. After intubation the onset of VAP was delayed in SSD group (14 +/- 8 day) as compared with the NON-SSD group (6 +/- 4 day) (P < 0.05). The same organisms were isolated by PSB among 61% (14/23) patients with VAP as what were previously isolated from the subglottic secretions.
Conclusions: The presence of subglottic secretion may be an origin of the pathogenetic organisms of VAP. The morbidity of VAP in mechanically ventilated patients can be reduced by SSD, especially for VAP caused by gram-positive cocci and Haemophilus influenzae organisms. SSD may be a simple and effective method for prevention of VAP.