title: Tracheotomy tubes with suction above the cuff reduce the rate of ventilator-associated pneumonia in intensive care unit patients.
abstract: OBJECTIVE
  We evaluated the effect of tracheotomy tubes that enable suction immediately above the cuff on the development of ventilator-associated pneumonia (VAP).
  
  
  METHODS
  Patients without preexisting pneumonia who required tracheotomy were randomly assigned to receive a tracheotomy tube with or without above-the-cuff suction. The suction tube provided 10 mm Hg of continuous wall suction while the tracheotomy tube cuff was inflated. Data regarding the development of VAP, time on the ventilator, and length of stay in the intensive care unit (ICU) were recorded and compared between groups.
  
  
  RESULTS
  Eighteen patients were randomized and prospectively evaluated. Nine patients received standard tracheotomy tubes, and 9 received suction-above-the-cuff tracheotomy tubes. The prevalences of VAP were 56% in the control group and 11% in the suction tracheotomy group (p = 0.02). The mean times on the ventilator were 18 +/- 14 days in the control group and 11 +/- 11 days in the suction group (p = 0.12). The mean lengths of ICU stay were 26 +/- 15 days in the control group and 18 +/- 15 days in the suction group (p = 0.14).
  
  
  CONCLUSIONS
  Use of suction-above-the-cuff tracheotomy tubes significantly decreases the incidence of VAP in ICU patients. There were trends toward decreased time on the ventilator and decreased length of stay in the ICU.
authors.affiliation: Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, CA 95817, USA.
authors.forename: Levi G
authors.initials: LG
authors.lastname: Ledgerwood
authors.forename: Moses D
authors.initials: MD
authors.lastname: Salgado
authors.forename: Hugh
authors.initials: H
authors.lastname: Black
authors.forename: Ken
authors.initials: K
authors.lastname: Yoneda
authors.forename: Ann
authors.initials: A
authors.lastname: Sievers
authors.forename: Peter C
authors.initials: PC
authors.lastname: Belafsky
mesh_terms: D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000517:prevention & control; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods; D015996:Survival Rate / Q000639:trends; D014140:Tracheotomy / Q000295:instrumentation*; D055815:Young Adult