title: Significant reduction in ventilator-associated pneumonia with the Venner-PneuX System in high-risk patients undergoing cardiac surgery: the Low Ventilator-Associated-Pneumonia study.
abstract: OBJECTIVE
  This study assessed whether the Venner-PneuX endotracheal tube (ET) system, which has sub-glottic suction as well as irrigation ports and continuous cuff-pressure monitoring, is associated with a reduction in ventilator-associated pneumonia (VAP) when compared with the standard ET in high-risk patients undergoing cardiac surgery.
  
  
  METHODS
  This was a single-institution, prospective, randomized control trial. Patients were categorized as either Group A (Venner-PneuX ET tube, n = 120) or Group B (Standard ET tube, n = 120). Inclusion criteria included patients over the age of 70 years and/or impaired left ventricular function (LVEF <50%) undergoing cardiac surgery. Patients were monitored for VAP for up to 48 h post extubation and the diagnosis of VAP was according to the centres for disease control definition.
  
  
  RESULTS
  There were no significant differences in the patients' demographics. The mean (SD) ages for the two groups were 72.4 (8.2) and 72.1 (7.4) years (P = 0.6), respectively. The mean EuroSCORE was 6.39 (2.2) for Group A and 6.48 (2.6) for Group B (P = 0.9). The median intubation times were 14.7 (7.3, 2927.2) h and 13 (2.5, 528.7) h, respectively. VAP incidence was significantly lower in the Venner-PneuX ET group, being 10.8% when compared with 21% in the standard ET group (P = 0.03). There was no significant difference between the two groups in terms of intensive care unit stay (P = 0.2) and in-hospital mortality (P = 0.2). A binary logistic regression analysis (type of ET tube, age, LVEF, history of lung disease, smoking history, surgical procedure, EuroSCORE, cardiopulmonary bypass time, blood transfusion, intubation duration among others) confirmed that the Venner-PneuX ET tube was associated with significant VAP reduction (Odds ratio 0.45, P = 0.03).
  
  
  CONCLUSIONS
  The Venner-PneuX VAP prevention system is associated with a significant reduction in VAP. This can potentially lead to significant cost reductions and should be implemented as part of the VAP reduction bundle.
authors.affiliation: Department of Intensive Care, Heart and Lung Centre, Wolverhampton, UK.
authors.forename: Shameer
authors.initials: S
authors.lastname: Gopal
authors.affiliation: Department of Cardiothoracic Surgery, Heart and Lung Centre, Wolverhampton, UK heymanluckraz@aol.com.
authors.forename: Heyman
authors.initials: H
authors.lastname: Luckraz
authors.affiliation: Department of Cardiothoracic Anaesthesiology, Heart and Lung Centre, Wolverhampton, UK.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Giri
authors.affiliation: University of Wolverhampton, Wolverhampton, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Nevill
authors.affiliation: Department of Cardiothoracic Surgery, Heart and Lung Centre, Wolverhampton, UK.
authors.forename: Israr
authors.initials: I
authors.lastname: Muhammed
authors.affiliation: Department of Infection Control, Heart and Lung Centre, Wolverhampton, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Reid
authors.affiliation: Department of Intensive Care, Heart and Lung Centre, Wolverhampton, UK.
authors.forename: Shelagh
authors.initials: S
authors.lastname: Bickerton
authors.affiliation: Department of Intensive Care, Heart and Lung Centre, Wolverhampton, UK.
authors.forename: Donna
authors.initials: D
authors.lastname: Jenkins
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D013396:Suction / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data
keywords: Sub-glottic suction drainage and irrigation; Ventilator-associated pneumonia