title: Predicting Which Patients will Likely Benefit from Subglottic Secretion Drainage Endotracheal Tubes: A Retrospective Study.
abstract: BACKGROUND
  Subglottic secretion drainage endotracheal tubes (SSD ETTs) have been shown to decrease ventilator-associated pneumonia and are recommended for patients intubated > 48 h or 72 h. However, it is difficult to determine which patients will be intubated > 48 h or 72 h at the time of intubation.
  
  
  OBJECTIVE
  We attempted to determine which patient characteristics were associated with intubations ≥ 48 h or 72 h in order to guide proper placement of SSD ETTs.
  
  
  METHODS
  The medical records of 2,159 ventilated patients at a single institution were retrospectively reviewed for intubation duration, age, sex, race, body mass index, weight, intubation reason, whether the intubation was emergent, operative status, intensive care unit (ICU) diagnosis, intubation location, ICU location, comorbidities (e.g., congestive heart failure, chronic obstructive pulmonary disorder, coronary artery disease, dementia, and liver disease), acute kidney injury (AKI), and chronic renal injury. A multivariate regression analysis was then performed with all reliable data.
  
  
  RESULTS
  The following were associated with intubation ≥ 48 h: neuroscience critical care unit (NCCU) admission (risk ratio [RR] = 1.85; 95% confidence interval [CI] 1.34-2.56), emergent intubation (RR = 1.97; 95% 1.28-3.03), comorbid dementia (RR = 2.31; 95% 1.28-4.18), nonoperative intubation (RR = 1.77; 95% 1.28-4.18), and AKI (RR = 3.32; 95% 2.56-4.3). The following were independently associated with intubation ≥ 72 h: NCCU admission (RR = 2.2; 95 CI 1.57-3.08), nonoperative intubation (RR = 3.38; 95% CI 2.63-4.35), comorbid dementia (RR = 3.03; 95% CI 1.67-5.48), and AKI (RR = 3.11; 95% CI 2.38-4.07).
  
  
  CONCLUSIONS
  Nonoperative intubation, emergent intubation, history of dementia, admission to NCCU and AKI all appear to be independently associated with increased RRs for either ≥ 48 h or 72 h of ventilation.
authors.affiliation: Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Darren P
authors.initials: DP
authors.lastname: Mareiniss
authors.affiliation: The Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Tim
authors.initials: T
authors.lastname: Xu
authors.affiliation: Department of Emergency Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Julius Cuong
authors.initials: JC
authors.lastname: Pham
authors.affiliation: Department of Emergency Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Hsieh
authors.affiliation: The Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Jiawei
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Emergency Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Christopher
authors.initials: C
authors.lastname: Nguyen
authors.affiliation: Department of Emergency Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Michael
authors.initials: M
authors.lastname: Nguyen
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Bradford
authors.initials: B
authors.lastname: Winters
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004322:Drainage / Q000379:methods*; D005260:Female; D005931:Glottis; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: VAP; intubation; prevention; subglottic secretion drainage endotracheal tubes; ventilator-associated pneumonia