title: Intermittent suction of oral secretions before each positional change may reduce ventilator-associated pneumonia: a pilot study.
abstract: BACKGROUND
  That ventilator-associated pneumonia (VAP) can be reduced by continuous and/or intermittent subglottic suction highlights the importance of clearance of oropharyngeal secretions. We prospectively evaluated the usefulness of intermittent suction of oral secretions before each positional change in reducing VAP.
  
  
  METHODS
  A time-sequence nonrandomized intervention design was used. The study consisted of a 9-month observation phase (control group, 237 patients), a 6-month education phase, followed by a 7-month intervention phase (studied group, 227 patients). The occurrence of VAP, duration of mechanical ventilation, length of intensive care unit (ICU) stay, and mortality were recorded.
  
  
  RESULTS
  VAP occurred less frequently in the studied group (6 of 227 patients, 2.6%) than in the control group (26 of 237 patients, 11.0%; P < 0.001). The incidence rate of VAP in control and studied groups was 6.51 and 2.04 per 1000 ventilator days, respectively (P = 0.002). For VAP patients, the ventilator days were 28.8 +/- 17.2 days and 20.2 +/- 4.0 days (P = 0.009), respectively, and the length of ICU stay was 27.6 +/- 17.0 days and 20.3 +/- 4.0 days (P = 0.012), respectively, in the control and studied groups. Intermittent suction of oral secretions before each positional change was the only independent factor responsible for a decrease of VAP in the studied group after stepwise logistic regression analysis (P = 0.003).
  
  
  CONCLUSIONS
  Intermittent suction of oral secretions before each positional change may reduce VAP occurrence in ICU patients.
authors.affiliation: Medical and Surgical Intensive Care Unit, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Hui-Hwa
authors.initials: HH
authors.lastname: Tsai
authors.forename: Fang-Chi
authors.initials: FC
authors.lastname: Lin
authors.forename: Shi-Chuan
authors.initials: SC
authors.lastname: Chang
mesh_terms: D012634:Bodily Secretions / Q000382:microbiology*; D003428:Cross Infection / Q000209:etiology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D010865:Pilot Projects; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D012121:Respiration, Artificial / Q000009:adverse effects*; D013396:Suction