title: Use of the Blom Tracheotomy Tube with Suction Inner Cannula to Decontaminate Microorganisms from the Subglottic Space. A Proof of Concept.
abstract: BACKGROUND
  Preventing pulmonary complications during mechanical ventilation via tracheotomy is a high priority.
  
  
  OBJECTIVE
  To investigate if the Blom tracheotomy tube with suction-above-the-cuff inner cannula reduced the quantity of normal flora and pathogens in supra- versus subglottic spaces.
  
  
  METHODS
  We enrolled 20 consecutive medical ICU adults requiring tracheostomy for mechanical ventilation in this proof-of-concept, prospective, single-center study. All participants received a Blom tracheotomy tube with suction-above-the-cuff inner cannula to decontaminate microorganisms from the supra- and subglottic spaces. Supra- and subglottic sputum samples were obtained for microbiologic analysis while an endotracheal tube was in place before tracheotomy and once per week for up to 4 weeks of mechanical ventilation after tracheotomy.
  
  
  RESULTS
  Demographics, duration of endotracheal tube intubation, and duration of mechanical ventilation post-tracheotomy were recorded. There was a significant reduction for supraglottic (2.86 ± 1.11 [mean ± SD]) versus subglottic suction samples (2.48 ± 1.07) (paired t test, P = 0.048; Wilcoxon test, P = 0.045) when all data pairs for normal flora and pathogens were combined across times. There was a significant reduction of normal flora pooled across times in 19 data pairs for supraglottic (3.00 ± 1.05) versus subglottic suction samples (2.00 ± 0.94) (paired t test, P = 0.0004; Wilcoxon test, P = 0.0007). There was no significant reduction of pathogens pooled across times in 25 data pairs for supraglottic (2.76 ± 1.16) versus subglottic suction samples (2.84 ± 1.03) (paired t test, P = 0.75; Wilcoxon test, P = 0.83).
  
  
  CONCLUSIONS
  Proof-of-concept was confirmed. The Blom tracheotomy tube with disposable suction-above-the-cuff inner cannula decontaminated microorganisms from the subglottic space when normal flora and pathogens were combined. Future research should investigate if decreased quantity of normal flora and pathogens in the subglottic space reduces the incidence of ventilator-associated pulmonary complications in critically ill patients requiring ongoing mechanical ventilation via tracheotomy.
authors: 1 Department of Surgery, Section of Otolaryngology.
authors: Lesley
authors: L
authors: Rabach
authors: 2 Department of Internal Medicine, Section of Pulmonary and Critical Care, and.
authors: Mark D
authors: MD
authors: Siegel
authors: 3 Department of Internal Medicine, Section of Pulmonary and Critical Care, Yale School of Medicine, New Haven, Connecticut.
authors: Jonathan T
authors: JT
authors: Puchalski
authors: 4 Department of Laboratory Medicine.
authors: Dana
authors: D
authors: Towle
authors: 5 Medical Intensive Care Unit, and.
authors: Michelle
authors: M
authors: Follert
authors: 6 Yale-New Haven Hospital, New Haven, Connecticut; and.
authors: Kelsey M
authors: KM
authors: Johnson
authors: 7 The Robert H. Lurie Comprehensive Cancer Center, Biostatistics Core Facility, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors: Alfred W
authors: AW
authors: Rademaker
authors: 1 Department of Surgery, Section of Otolaryngology.
authors: Steven B
authors: SB
authors: Leder
mesh_terms: D000328:Adult; D000368:Aged; D003237:Connecticut; D005260:Female; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods / Q000592:standards; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007830:Larynx / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control; D058996:Quality Improvement; D012121:Respiration, Artificial / Q000009:adverse effects*; D013396:Suction / Q000295:instrumentation / Q000379:methods; D013997:Time Factors; D014140:Tracheotomy / Q000379:methods*
keywords: intensive care unit; mechanical ventilation; tracheotomy; ventilator-associated pneumonia