title: Subglottic secretion drainage and continuous control of cuff pressure used together save health care costs.
abstract: BACKGROUND
  Preventive strategies to reduce ventilator-associated respiratory infection (VARI) include the use of an endotracheal tube incorporating a lumen for subglottic secretion drainage (SSD) and a system for continuous control of endotracheal tube cuff pressure (CCCP). The health care costs associated with the combined use of these 2 measures aimed at preventing VARI are not known, however. The objective of this study was to determine whether the simultaneous use of these 2 preventive measures for VARI could save health care costs.
  
  
  METHODS
  We performed a prospective observational study of patients who needed mechanical ventilation in an intensive care unit. The health care costs considered here included only the costs of the endotracheal tube, cuff control, and antimicrobials used to treat VARI.
  
  
  RESULTS
  The study cohort comprised 656 patients, including 241 with intermittent control of cuff pressure and without SSD (standard group), 260 with CCCP and without SSD (CCCP group), 84 with intermittent control of cuff pressure and with SSD (SSD group), and 71 with CCCP and SSD (CCCP + SSD group). The incidence of VARI and health care costs were lower in the CCCP + SSD group compared with the standard, CCCP, and SSD groups.
  
  
  CONCLUSIONS
  The combined use of SSD and CCCP reduced the incidence of VARI and saved health care costs.
authors.affiliation: Department of Critical Care, University Hospital of the Canary Islands, La Laguna, Tenerife, Spain. Electronic address: lorentemartin@msn.com.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Lorente
authors.affiliation: Department of Microbiology and Infection Control, University Hospital of the Canary Islands, La Laguna, Tenerife, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Lecuona
authors.affiliation: Research Unit, University Hospital of the Canary Islands, La Laguna, Tenerife, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Jiménez
authors.affiliation: Department of Critical Care, University Hospital of the Canary Islands, La Laguna, Tenerife, Spain.
authors.forename: Judith
authors.initials: J
authors.lastname: Cabrera
authors.affiliation: Department of Critical Care, University Hospital of the Canary Islands, La Laguna, Tenerife, Spain.
authors.forename: María L
authors.initials: ML
authors.lastname: Mora
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D012634:Bodily Secretions; D015331:Cohort Studies; D004322:Drainage / Q000191:economics / Q000379:methods*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007442:Intubation, Intratracheal / Q000191:economics / Q000379:methods*; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000191:economics / Q000517:prevention & control*; D011312:Pressure; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*
keywords: Mechanical ventilation; Pneumonia; Respiratory infection; Ventilator