Prevention of nosocomial pneumonia in intubated patients: respective role of mechanical subglottic secretions drainage and stress ulcer prophylaxis.
Chronic microaspiration through a tracheal cuff is the main culprit in the penetration and colonization of the lower respiratory tract. A total of 145 patients intubated for more than 3 days were randomly assigned to a double nosocomial pneumonia (NP) prevention: 1--Prevention of aspiration by hourly subglottic secretion drainage (SSD) with a specific endotracheal tube (HI-LO Evac tube, Mallinckrodt); 2--Prevention of gastric colonization using either sucralfate or antacids. Four random groups were defined, similar in age and severity of illness. Subglottic secretion drainage treatment was associated with: a) a twice lower incidence of NP (no-SSD: 29.1%, SSD: 13%); b) a prolonged time of onset of NP (no-SSD: 8.3 +/- 5 days, SSD: 16.2 +/- 11 days); c) a decrease in the colonization rate from admission to end-point day in tracheal aspirates (no-SSD: +21.3%, SSD: +6.6%) and in subglottic secretions (no-SSD: +33.4%, SSD: +2.1%). Sucralfate was not associated with a significantly lower incidence of NP (antacids: 23.6%, sucralfate: 17.8%), but with a lower increase in the colonization rate in subglottic and gastric aspirates, from admission to end-point day.
Mahul
P
P
Service de Réanimation Polyvalente, Hôpital Nord, CHRU St. Etienne, France.
Auboyer
C
C
Jospe
R
R
Ros
A
A
Guerin
C
C
el Khouri
Z
Z
Galliez
M
M
Dumont
A
A
Gaudin
O
O
D000328:Adult; D000368:Aged; D000863:Antacids / Q000494:pharmacology / Q000627:therapeutic use; D015169:Colony Count, Microbial; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D003663:Decision Trees; D005260:Female; D005602:France / Q000453:epidemiology; D005745:Gastric Acidity Determination; D006801:Humans; D015994:Incidence; D007239:Infections / Q000382:microbiology; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D011015:Pneumonia, Aspiration / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D013272:Stomach Diseases / Q000382:microbiology / Q000517:prevention & control*; D013315:Stress, Psychological / Q000150:complications; D013392:Sucralfate / Q000494:pharmacology / Q000627:therapeutic use; D013396:Suction / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D016896:Treatment Outcome
D000863:Antacids; D013392:Sucralfate