A COMPARATIVE STUDY OF THE EFFICACY OF THE ENDOTRACHEAL TUBE WITH A SUBGLOTTIC SUCTION SYSTEM TO MINIMIZE THE RISK OF VENTILATOR-ASSOCIATED PNEUMONIA

Montosh Kumar Mondal*, Debasish Banik, Sabina Yeasmeen and Debabrata Banik

ABSTRACT

Background: Ventilator-associated pneumonia (VAP) is a common condition in patients who are endotracheally intubatedin intensive care units (ICU). Subglottic secretion drainage (SSD) has been shown to be associated with a lower incidence of ventilator-associated pneumonia (VAP). Objective: The main objective of this prospective study is to establish the effect of endotracheal tube (ETT) with a subglottic suction device in reducing the risk of VAPin patients receiving mechanical ventilation. Method: This prospective observational study included 80 adult patients on mechanical ventilation from the ICU of Bangabandhu Sheikh Mujib Medical University, Dhaka from July 2017 to June 2019. Patients were divided into two groups: one with an endotracheal tube with a subglottic suction device(SSD) (Group-A, n = 40) and the other with a conventional endotracheal tube (Group-B, n = 40). Data were collected by taking a comprehensive history, clinical review, investigation, including tracheal aspiration culture, to determine the presence or absence of ventilator-associated pneumonia (VAP) in mechanically ventilated patients. The occurrence of VAP was compared between Group-A and Group-B and the relative risk (RR) of developing VAP was estimated in patients with SSD. Results: Group-A and Group-B were almost the same in terms of demographic characteristics (age and sex). Smoking practices were almost similar between classes. The purpose of admission to the ICU was not different between groups (p = 0.294). The mean length of mechanical ventilation was also statistically comparable. Related co-morbidities in the distribution between groups were also similar. 10 of the 40 (25%) patients in Group-A and 22 (55%) of the 40 patients in Group-B developed VAP. The probability of developing VAP in Group-A was lower than in Group-B. The predominantly cultivated microorganisms were acinatobacter (in both groups). Conclusion: Endotracheal tube with intermittent SSD on mechanical ventilator helps to reduce ventilator-associated pneumonia.

Keywords: Subglottic secretion, Ventilator-associated pneumonia, Intensive care unit, Mechanical ventilator and Endotracheal tube.