title: Prevention of ventilator-associated pneumonia and ventilator-associated conditions: a randomized controlled trial with subglottic secretion suctioning.
abstract: OBJECTIVE
  Ventilator-associated pneumonia diagnosis remains a debatable topic. New definitions of ventilator-associated conditions involving worsening oxygenation have been recently proposed to make surveillance of events possibly linked to ventilator-associated pneumonia as objective as possible. The objective of the study was to confirm the effect of subglottic secretion suctioning on ventilator-associated pneumonia prevalence and to assess its concomitant impact on ventilator-associated conditions and antibiotic use.
  
  
  METHODS
  Randomized controlled clinical trial conducted in five ICUs of the same hospital.
  
  
  METHODS
  Three hundred fifty-two adult patients intubated with a tracheal tube allowing subglottic secretion suctioning were randomly assigned to undergo suctioning (n = 170, group 1) or not (n = 182, group 2).
  
  
  RESULTS
  During ventilation, microbiologically confirmed ventilator-associated pneumonia occurred in 15 patients (8.8%) of group 1 and 32 patients (17.6%) of group 2 (p = 0.018). In terms of ventilatory days, ventilator-associated pneumonia rates were 9.6 of 1,000 ventilatory days and 19.8 of 1,000 ventilatory days, respectively (p = 0.0076). Ventilator-associated condition prevalence was 21.8% in group 1 and 22.5% in group 2 (p = 0.84). Among the 47 patients with ventilator-associated pneumonia, 25 (58.2%) experienced a ventilator-associated condition. Neither length of ICU stay nor mortality differed between groups; only ventilator-associated condition was associated with increased mortality. The total number of antibiotic days was 1,696 in group 1, representing 61.6% of the 2,754 ICU days, and 1,965 in group 2, representing 68.5% of the 2,868 ICU days (p < 0.0001).
  
  
  CONCLUSIONS
  Subglottic secretion suctioning resulted in a significant reduction of ventilator-associated pneumonia prevalence associated with a significant decrease in antibiotic use. By contrast, ventilator-associated condition occurrence did not differ between groups and appeared more related to other medical features than ventilator-associated pneumonia.
authors.affiliation: 1Department of General Intensive Care, University Hospital of Liege, Liège, Belgium. 2Department of Medicine, University Hospital of Liege, Liège, Belgium. 3Department of Emergency Medicine, University Hospital of Liege, Liège, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Damas
authors.forename: Frédéric
authors.initials: F
authors.lastname: Frippiat
authors.forename: Arnaud
authors.initials: A
authors.lastname: Ancion
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Canivet
authors.forename: Bernard
authors.initials: B
authors.lastname: Lambermont
authors.forename: Nathalie
authors.initials: N
authors.lastname: Layios
authors.forename: Paul
authors.initials: P
authors.lastname: Massion
authors.forename: Philippe
authors.initials: P
authors.lastname: Morimont
authors.forename: Monique
authors.initials: M
authors.lastname: Nys
authors.forename: Sonia
authors.initials: S
authors.lastname: Piret
authors.forename: Patrizio
authors.initials: P
authors.lastname: Lancellotti
authors.forename: Patricia
authors.initials: P
authors.lastname: Wiesen
authors.forename: Vincent
authors.initials: V
authors.lastname: D'orio
authors.forename: Nicolas
authors.initials: N
authors.lastname: Samalea
authors.forename: Didier
authors.initials: D
authors.lastname: Ledoux
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D015995:Prevalence; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D013396:Suction / Q000379:methods*
chemical_list: D000900:Anti-Bacterial Agents