title: A prospective randomized trial of tapered-cuff endotracheal tubes with intermittent subglottic suctioning in preventing ventilator-associated pneumonia in critically ill patients.
abstract: Endotracheal tube placement is necessary for the control of the airway in patients who are mechanically ventilated. However, prolonged duration of endotracheal tube placement contributes to the development of ventilator-associated pneumonias (VAPs). The aim of this study was to evaluate whether subglottic suctioning using TaperGuard EVAC tubes was effective in decreasing the frequency of VAP.
  
  
  
  A total of 276 mechanically ventilated patients for more than 72 hours were randomly assigned to group E (EVAC tube) and group C (conventional tube). All patients received routine care including VAP prevention measures during their intensive care unit stay. In group E, subglottic suctioning was performed every 6 hours. Outcome variables included incidence VAP, intensive care unit length of stay, and mortality.
  
  
  
  Frequency of intraluminal suction, mechanical ventilation-free days, reintubation, the ratio of arterial oxygen partial pressure to fractional inspired oxygen and mortality rate were similar between the 2 groups (P > .05). The mean cuff pressure in group E was significantly less than that in group C (P < .001). Ventilator-associated pneumonia was significantly less in group E compared with group C (P = .015).
  
  
  
  The use of intermittent subglottic secretion suctioning was associated with a significant decrease in the incidence of the VAP in critically ill patients. However, larger multicenter trials are required to arrive at a concrete decision on routine usage of TaperGuard tubes in critical care settings.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address: amahmoodpoor@yahoo.com.
authors.forename: Ata
authors.initials: A
authors.lastname: Mahmoodpoor
authors.affiliation: Department of Clinical Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address: hamishehkar@gmail.com.
authors.forename: Hadi
authors.initials: H
authors.lastname: Hamishehkar
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address: masoodhamidi59@yahoo.com.
authors.forename: Masoud
authors.initials: M
authors.lastname: Hamidi
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address: k_shadvar@yahoo.com.
authors.forename: Kamran
authors.initials: K
authors.lastname: Shadvar
authors.affiliation: Tuberculosis and Lung Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address: sarvin_so2000@yahoo.com.
authors.forename: Sarvin
authors.initials: S
authors.lastname: Sanaie
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address: dr.golzari@hotmail.com.
authors.forename: Samad Ej
authors.initials: SE
authors.lastname: Golzari
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: Khanzh51@yahoo.com.
authors.forename: Zahid Hussain
authors.initials: ZH
authors.lastname: Khan
authors.affiliation: Department of Anesthesiology, 252 Farber Hall, State University of New York at Buffalo, 3435 Main St, Buffalo, NY 14214. Electronic address: nnader@buffalo.edu.
authors.forename: Nader D
authors.initials: ND
authors.lastname: Nader
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D016638:Critical Illness; D005260:Female; D005931:Glottis; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D007492:Iran; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000401:mortality / Q000517:prevention & control*; D011446:Prospective Studies; D013396:Suction / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
keywords: Intensive care units; TaperGuard endotracheal tubes; Ventilator-associated pneumonia