Airway colonisation in long-term mechanically ventilated patients. Effect of semi-recumbent position and continuous subglottic suctioning.
OBJECTIVE
To evaluate the impact of continuous subglottic suctioning and semi-recumbent body position on bacterial colonisation of the lower respiratory tract.


METHODS
A randomised controlled trial.


METHODS
The ten-bed medical ICU of a French university hospital.


METHODS
Critically ill patients expected to require mechanical ventilation for more than 5 days.


METHODS
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.


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.


CONCLUSIONS
Tracheal colonisation in long-term mechanically ventilated ICU patients was not modified by the use of continuous subglottic suctioning and semi-recumbent body position.
Girou
Emmanuelle
E
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.
Buu-Hoi
Annie
A
Department of Microbiology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 20-40 rue Leblanc, 75015, Paris, France.
Stephan
François
F
Department of Anesthesiology, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, 51 avenue Mal de Lattre de Tassigny, 94010, Créteil, France.
Novara
Ana
A
Medical Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 20-40 rue Leblanc, 75015, Paris, France.
Gutmann
Laurent
L
Department of Microbiology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 20-40 rue Leblanc, 75015, Paris, France.
Safar
Michel
M
Department of Internal Medicine, Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, 1 place du Parvis Notre Dame, 75004, Paris, France.
Fagon
Jean-Yves
JY
Medical Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 20-40 rue Leblanc, 75015, Paris, France.
D000368:Aged; D003422:Critical Care / Q000379:methods*; D005260:Female; D005602:France; D006801:Humans; D007362:Intensive Care Units; D007830:Larynx / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000009:adverse effects*; D013396:Suction / Q000379:methods*; D016683:Supine Position; D013997:Time Factors; D014132:Trachea / Q000382:microbiology; D016896:Treatment Outcome