title: Impact of subglottic suctioning on the incidence of pneumonia after cardiac surgery: a retrospective observational study.
abstract: OBJECTIVE
  Continuous aspiration of subglottic secretions (CASS) has been found to decrease the incidence of pneumonia in the general intensive care unit (ICU) population, but its benefit in cardiac surgery patients is unclear. The present study aimed to determine whether the routine use of CASS in cardiac surgical patients was associated with decreased pneumonia.
  
  
  METHODS
  A retrospective, single-center observational study.
  
  
  METHODS
  The study was conducted in a quaternary care cardiac surgery center and university research hospital.
  
  
  METHODS
  4,880 patients undergoing cardiac surgery were studied.
  
  
  METHODS
  The control group (no CASS) received a standard endotracheal tube and underwent surgery between April 1, 2007 and March 31, 2009. The intervention group (CASS) received a subglottic suctioning endotracheal tube and underwent surgery between June 1, 2009 and May 31, 2011. The primary outcome was the development of pneumonia, and the secondary outcomes were 30-day in-hospital mortality, ventilation time, need for tracheostomy, ICU length of stay (LOS), and hospital LOS.
  
  
  RESULTS
  The unadjusted incidence of pneumonia was 1.9% in the CASS group and 5.6% in the control group (p<0.0001). The CASS group also had lower 30-day in-hospital mortality (2.1% v 3.3%; p = 0.007), median ventilation time (8.42 v 7.3 hours; p<0.0001), and shorter median ICU LOS (1.77 v 1.17 days; p<0.0004) compared with the control group. Tracheostomy rates and median hospital LOS did not differ between groups. After adjusting using multivariable modeling, CASS remained an independent risk predictor for pneumonia (odds ratio [OR] 0.342, 95% confidence interval [CI] 0.239-0.490) and ICU LOS (OR 0.817, 95% CI 0.718-0.931).
  
  
  CONCLUSIONS
  The universal implementation of CASS in a quaternary care cardiac surgical population was associated with a decreased incidence of pneumonia.
authors.affiliation: Department of Anesthesiology, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: chudson@ottawaheart.ca.
authors.forename: Jordan K C
authors.initials: JK
authors.lastname: Hudson
authors.affiliation: Division of Cardiac Anesthesiology and Critical Care Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: McDonald
authors.affiliation: Division of Cardiac Anesthesiology and Critical Care Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: John C
authors.initials: JC
authors.lastname: MacDonald
authors.affiliation: Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Ruel
authors.affiliation: Division of Cardiac Anesthesiology and Critical Care Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Christopher C C
authors.initials: CC
authors.lastname: Hudson
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000639:trends*; D005260:Female; D005931:Glottis; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D013396:Suction / Q000379:methods
keywords: VAP prevention bundle; cardiac surgery; intensive care; pneumonia; subglottic suctioning; ventilator-associated pneumonia