title: Efficacy of intermittent sub-glottic suctioning in prevention of ventilator-associated pneumonia- A preliminary study of 100 patients.
abstract: OBJECTIVE
  Oropharyngeal colonisation followed by aspiration of contaminated secretions is the major cause for ventilator-associated pneumonia (VAP). Pooled secretions present in the sub-glottic area above inflated endotracheal tube cuff may be aspirated into the lower airways. It was hypothesised that intermittent suctioning of sub-glottic secretions would prevent VAP.
  
  
  METHODS
  Group I (n = 50) patients were intubated with HiLo Evac™ endotracheal (ET) tube with facility for sub-glottic suctioning, and Group II (n = 50) patients were intubated with HiLo Contour™ ET tube without such facility. In the Group I, sub-glottic suctioning was performed every 2 h. Incidence of VAP, mean ventilator days, Intensive Care Unit (ICU) stay and mortality were compared. Qualitative variables were reported as percentages and were compared by Chi-square test or unpaired two-tailed, Fisher's exact test, as appropriate, to analyse the significance of difference between the two groups.
  
  
  RESULTS
  The two groups were similar with respect to demographic characteristics. VAP was seen in 6% of patients in Group I and 22% of patients in Group II (P = 0.021). Both early- and late-onset VAPs were significantly reduced in Group I. Both ventilator days (8.0 vs. 6.45; P = 0.001) and ICU stay (8.33 vs. 6.33; P = 0.001) on the day of onset of VAP were significantly more in the Group I. Total ventilator days were significantly less (6.52 vs. 8.32; P = 0.006) with lower incidence of mortality (36% vs. 48%; P = 0.224) in the Group I.
  
  
  CONCLUSIONS
  Intermittent sub-glottic suctioning reduces the incidence of VAP including late-onset VAP.
authors.affiliation: Department of Anaesthesia and Critical Care, Command Hospital, Air Force, Bengaluru, Karnataka, India.
authors.forename: M N
authors.initials: MN
authors.lastname: Vijai
authors.affiliation: Department of Anaesthesia and Critical Care, Command Hospital, Air Force, Bengaluru, Karnataka, India.
authors.forename: Parli R
authors.initials: PR
authors.lastname: Ravi
authors.affiliation: Department of Anaesthesia and Critical Care, Command Hospital, Air Force, Bengaluru, Karnataka, India.
authors.forename: Rangaraj
authors.initials: R
authors.lastname: Setlur
authors.affiliation: Department of Anaesthesia and Critical Care, Command Hospital, Air Force, Bengaluru, Karnataka, India.
authors.forename: Harsh
authors.initials: H
authors.lastname: Vardhan
keywords: Aspiration; intubation; mechanical ventilation; sub-glottic secretion drainage; ventilator-associated pneumonia