title: Effect of intermittent subglottic secretion drainage on ventilator-associated pneumonia: A clinical trial.
abstract: BACKGROUND
  Secretions contaminated with oral, nasal, and gastric bacteria accumulate in the subglottic space, above the endotracheal tube cuff. If these secretions are aspirated into lower airways, the intubated patient will be susceptible to ventilator-associated pneumonia (VAP). The aim of this study was to investigate the effect of inspiratory pause maneuver for intermittent subglottic secretions drainage (SSD) on the incidence of VAP in patients receiving mechanical ventilation.
  
  
  METHODS
  This randomized clinical trial was conducted in four intensive care units of educational hospital in Isfahan, Iran. A total of 76 adult patients intubated with a conventional endotracheal tube and connected to ventilators for more than 48 h were selected through convenient sampling and were randomly assigned to undergo intermittent SSD (n = 38) or not (n = 38). In this study, for SSD, we used inspiratory pause/hold key in the ventilators to hyperinflate the lungs. Pressure that produces with this maneuver could remove the secretions from the subglottic space.
  
  
  RESULTS
  VAP was found in 10 (26.3%) patients receiving SSD and in 18 (47.4%) patients in the control group (P = 0.04).
  
  
  CONCLUSIONS
  SSD using inspiratory pause during mechanical ventilation results in a significant reduction in VAP.
authors.affiliation: Department of Critical Care Nursing, Nursing and Midwifery School, Isfahan, Iran.
authors.forename: Rahimeh
authors.initials: R
authors.lastname: Safdari
authors.affiliation: Department of Critical Care Nursing, Nursing and Midwifery School, Isfahan, Iran.
authors.forename: Ahmadreza
authors.initials: A
authors.lastname: Yazdannik
authors.affiliation: Department of Anesthesiology and Intensive Care, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Saeed
authors.initials: S
authors.lastname: Abbasi
keywords: Critically ill patients; intensive care unit; subglottic secretions drainage; ventilator-associated pneumonia