scholarly journals Efficacy of Hi-Lo Evac Endotracheal Tube in Prevention of Ventilator-Associated Pneumonia in Mechanically Ventilated Poisoned Patients

Scientifica ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Ahmad Ghoochani Khorasani ◽  
Shahin Shadnia ◽  
Mohammad Mashayekhian ◽  
Mitra Rahimi ◽  
Abbas Aghabiklooei
Keyword(s):  
Endotracheal Tube ◽  
Control Group ◽  
Case Group ◽  
Ventilator Associated Pneumonia ◽  
Mechanically Ventilated ◽  
Subglottic Secretion ◽  
Icu Length Of Stay ◽  
Significant Difference ◽  
Subglottic Secretion Drainage ◽  
Health Care Associated Infection

Background. Ventilator-associated pneumonia (VAP) is the most common health care-associated infection. To prevent this complication, aspiration of subglottic secretions using Hi-Lo Evac endotracheal tube (Evac ETT) is a recommended intervention. However, there are some reports on Evac ETT dysfunction. We aimed to compare the incidence of VAP (per ventilated patients) in severely ill poisoned patients who were intubated using Evac ETT versus conventional endotracheal tubes (C-ETT) in our toxicology ICU.Materials and Methods. In this clinical randomized trial, 91 eligible patients with an expected duration of mechanical ventilation of more than 48 hours were recruited and randomly assigned into two groups: (1) subglottic secretion drainage (SSD) group who were intubated by Evac ETT (n=43) and (2) control group who were intubated by C-ETT (n=48).Results. Of the 91 eligible patients, 56 (61.5%) were male. VAP was detected in 24 of 43 (55.8%) patients in the case group and 23 of 48 (47.9%) patients in the control group (P=0.45). The most frequently isolated microorganisms wereS. aureus(54.10%) andAcinetobacterspp. (19.68%). The incidence of VAP and ICU length of stay were not significantly different between the two groups, but duration of intubation was statistically different and was longer in the SSD group. Mortality rate was less in SSD group but without a significant difference (P=0.68).Conclusion. The SSD procedure was performed intermittently with one-hour intervals using 10 mL syringe. Subglottic secretion drainage does not significantly reduce the incidence of VAP in patients receiving MV. This strategy appears to be ineffective in preventing VAP among ICU patients.

scholarly journals Ventilator Associated Pneumonia in Patients Using Endotracheal Tube with Intermittent Subglottic Secretion Drainage and Using Endotracheal Tube without Drainage

2021 ◽  
Vol 9 (4) ◽  
pp. 506-511
Author(s):  
  Md. Zubyeer Ali Sheikh ◽  
A. K. Qumrul Huda ◽  
Montosh Kumar Mondal ◽  
Md. Mohiuddin Majed Chy ◽  
Mohammad Mahbubuzzaman ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Ventilator Associated Pneumonia ◽  
Subglottic Secretion ◽  
Subglottic Secretion Drainage

scholarly journals EARLY PROBIOTICS IN PREVENTING VENTILATOR-ASSOCIATED PNEUMONIA AFTER MULTIPLE TRAUMA

2020 ◽  
pp. 83-85
Author(s):  
TAMER HABIB ◽  
AMIRA B KASSEM ◽  
ISLAM AHMED
Keyword(s):  
Multiple Trauma ◽  
University Hospital ◽  
Control Group ◽  
Trauma Patients ◽  
Ventilator Associated Pneumonia ◽  
Mechanically Ventilated ◽  
Significant Difference ◽  
Multiple Trauma Patients ◽  
And Control

Objective: Using probiotics in preventing ventilator-associated pneumonia (VAP) remain controversial due to different intensive care unit (ICU) populations included in such studies. The aim of this study is to evaluate the role of probiotics in prophylaxis of VAP after multiple trauma. Methods: Sixty-five adult multiple trauma patients on mechanical ventilator (expected ≥48 h) after admission to the Critical Care Medicine Department, Alexandria Main University Hospital from June to November 2018. Patients were randomly assigned using computer sheet into two groups; probiotics group (32 patients received one Lacteol Forte® sachet through orogastric/nasogastric tube 3 times daily during their ICU stay) and control group (33 patients received similar regimen of placebo sachets). All patients were followed up and subjected to all possible strategies of the diagnosis of microbiologically confirmed VAP. Results: Sixty-five patients were enrolled with a mean of age (39.48±7.692) years, 80% of them were male. Regarding the incidence of VAP, it was 18.46% of all patients without statistically significant difference between probiotics group (15.63%) and control group (21.21%) (p=0.751). Conclusion: Routine use of early probiotics in mechanically ventilated multiple trauma patients was not associated with lower incidence of VAP, duration of MV, or ICU mortality.

scholarly journals A comparative study on prevention of ventilator associated pneumonia using endotracheal tube with or without intermittent subglottic secretion drainage device

2018 ◽  
Vol 6 (1) ◽  
pp. 7-15
Author(s):  
Mohammad Asaduzzaman ◽  
Mohammad Omar Faruq ◽  
ASM Areef Ahsan ◽  
Kaniz Fatema ◽  
Fatema Ahmed ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Primary Outcome ◽  
Late Onset ◽  
Clinical Suspicion ◽  
Ventilator Associated Pneumonia ◽  
Quantitative Culture ◽  
Subglottic Secretion ◽  
Drainage Device ◽  
Subglottic Secretion Drainage ◽  
Substantial Morbidity

Context: Ventilator-associated pneumonia (VAP) causes substantial morbidity and mortality. The influence of intermittent subglottic secretion drainage (SSD) in preventing VAP has been supported by literature studies.Objective: To find out the effectiveness of subglottic secretion drainage (SSD) on prevention of ventilator associated pneumonia (VAP) using endotracheal tube with subglottic secretion drainage (ETT-SSD).Methodology: This study was carried out in the 10 beded medical-care Intensive Care Unit (ICU) of BIRDEM Hospital, Dhaka over a period of one and half year, enrolling 48 subjects. Patients expected to require mechanical ventilation (MV) for more than >48 hrs were randomly assigned to one of two groups: one was ventilated with ETT-SSD and the other with conventional endotracheal tube (ETT-C).Results: Primary outcome was the overall incidence of VAP based on quantitative culture of distal pulmonary samplings performed after each clinical suspicion. Other outcomes included incidence of early and late onset VAP, duration of MV, duration of ICU stay and in hospital mortality. Microbiologically confirmed VAP occurred in 23 patients, 6 of 24 (25%) in the SSD group and 17 of 24 (70.83%) in the control group.Conclusion: The use of an ETT with intermittent SSD in a patient on MV helps to prevent ventilator associated pneumonia.Bangladesh Crit Care J March 2018; 6(1): 7-15

scholarly journals Rapid-Flow Expulsion Maneuver in Subglottic Secretion Clearance to Prevent Ventilator-Associated Pneumonia: A Randomized Controlled Study

2021 ◽  
Author(s):  
Ying Li ◽  
Xue Yuan ◽  
Bing Sun ◽  
Hai-chao Li ◽  
Hui-wen Chu ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Controlled Trial ◽  
Tertiary Hospital ◽  
Controlled Study ◽  
Laryngeal Edema ◽  
Ventilator Associated Pneumonia ◽  
Subglottic Secretion ◽  
Icu Length Of Stay ◽  
Rapid Flow ◽  
Registration Number

Abstract Background: Following endotracheal intubation, clearing secretions above the endotracheal tube cuff decreases the incidence of ventilator-associated pneumonia (VAP); therefore, subglottic secretion drainage (SSD) is widely advocated. Our group developed a novel technique to remove the subglottic secretions, the rapid-flow expulsion maneuver (RFEM). The objective of this study is to explore the effectiveness and safety of RFEM compared with SSD.Methods: This study was a single center, prospective, randomized and controlled trial, conducted at Respiratory Intensive Care Unit (ICU) of Beijing Chao-Yang Hospital, a university-affiliated tertiary hospital. The primary outcome was the incidence of VAP, assessed for non-inferiority.Results: Patients with an endotracheal tube allowing drainage of subglottic secretions (n=241) were randomly assigned to either the RFEM group (n=120) or SSD group (n=121). Eleven patients (9.17%) in the RFEM group and 13 (10.74%) in the SSD group developed VAP (difference, -1.59; 95% confidence interval [CI], [-9.20 6.03]), as the upper limit of 95% CI was not greater than pre-defined non-inferiority limit(10%), RFEM was declared non-inferior to SSD. There were no statistically significant differences in the duration of mechanical ventilation, ICU mortality, or ICU length of stay and costs between groups. In terms of safety, no accidental extubation or maneuver-related barotrauma occurred in the RFEM group. The incidence of post-extubation laryngeal edema and reintubation was similar in both groups.Conclusions: RFEM is effective and safe, with non-inferiority compared to SSD in terms of the incidence of VAP. RFEM could be an alternative method in first-line treatment of respiratory ICU patients. Trial registration: This study has been registered on ClinicalTrials.gov (registration number: NCT02032849, https://clinicaltrials.gov/ct2/show/NCT02032849); registered on January 2014.

scholarly journals Rapid-flow expulsion maneuver in subglottic secretion clearance to prevent ventilator-associated pneumonia: a randomized controlled study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ying Li ◽  
Xue Yuan ◽  
Bing Sun ◽  
Hai-chao Li ◽  
Hui-wen Chu ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Controlled Trial ◽  
Tertiary Hospital ◽  
Controlled Study ◽  
Laryngeal Edema ◽  
Ventilator Associated Pneumonia ◽  
Subglottic Secretion ◽  
Icu Length Of Stay ◽  
Rapid Flow ◽  
Registration Number

Abstract Background Following endotracheal intubation, clearing secretions above the endotracheal tube cuff decreases the incidence of ventilator-associated pneumonia (VAP); therefore, subglottic secretion drainage (SSD) is widely advocated. Our group developed a novel technique to remove the subglottic secretions, the rapid-flow expulsion maneuver (RFEM). The objective of this study was to explore the effectiveness and safety of RFEM compared with SSD. Methods This study was a single-center, prospective, randomized and controlled trial, conducted at Respiratory Intensive Care Unit (ICU) of Beijing Chao-Yang Hospital, a university-affiliated tertiary hospital. The primary outcome was the incidence of VAP, assessed for non-inferiority. Results Patients with an endotracheal tube allowing drainage of subglottic secretions (n = 241) were randomly assigned to either the RFEM group (n = 120) or SSD group (n = 121). Eleven patients (9.17%) in the RFEM group and 13 (10.74%) in the SSD group developed VAP (difference, − 1.59; 95% confidence interval [CI] [− 9.20 6.03]), as the upper limit of 95% CI was not greater than the pre-defined non-inferiority limit (10%), RFEM was declared non-inferior to SSD. There were no statistically significant differences in the duration of mechanical ventilation, ICU mortality, or ICU length of stay and costs between groups. In terms of safety, no accidental extubation or maneuver-related barotrauma occurred in the RFEM group. The incidence of post-extubation laryngeal edema and reintubation was similar in both groups. Conclusions RFEM is effective and safe, with non-inferiority compared to SSD in terms of the incidence of VAP. RFEM could be an alternative method in first-line treatment of respiratory ICU patients. Trial registration This study has been registered on ClinicalTrials.gov (Registration Number: NCT02032849, https://clinicaltrials.gov/ct2/show/NCT02032849); registered on January 2014

scholarly journals Investigating the Role of Subglottic Secretions Suctioning in the Prevention of ‎Ventilator Associated Pneumonia in Patients With Invasive Mechanical ‎Ventilation

2019 ◽  
Vol 11 (6) ◽  
pp. 111
Author(s):  
Iyad Abbas Salman ◽  
Waleed Ibraheem Ali ◽  
Amir Ibrahim Moushib ◽  
Hayder Adnan Fawzi
Keyword(s):  
Mechanical Ventilation ◽  
Endotracheal Tube ◽  
Invasive Mechanical Ventilation ◽  
Tracheal Aspirate ◽  
Ventilator Associated Pneumonia ◽  
Mechanically Ventilated ◽  
Subglottic Secretion ◽  
Radiological Features ◽  
Ventilated Patients

BACKGROUND: development of ventilator associated pneumonia (VAP) leads to ‎prolonged hospital stay, increased health care cost, and mortality rates. Subglottic ‎secretion drainage through a dedicated endotracheal tube has been advocated as a mean ‎to decrease the incidence of VAP and thereby assisting in ‎the decrease of morbidity associated with invasive mechanical ventilation.‎ OBJECTIVE: Investigate the role of subglottic secretion suctioning in the prevention of VAP in mechanically ventilated patients in intensive care unit.‎ METHODS: A cross sectional study done in the intensive care unit of Ghazi Al-Hariri ‎hospital for surgical specialties in medical city complex, 30 patients who ‎are in need for invasive mechanical ventilation were intubated with endotracheal tube ‎that have special port for subglottic secretion suctioning. Daily monitoring of patients ‎clinical and radiological data to detect features of VAP was ‎done, and if there was a suspicion of pneumonia, culture for tracheal aspirate performed ‎to confirm diagnosis.‎ RESULTS: ‎Patient’s age was 37.1 ± ‎‎15.39 years, the highest proportion of study patients was found in ‎age group < 30 and ‎‎30–49 years (40% in ‎each group), most of the patients were males (70%) with a male to female ratio of ‎‎2.33:1‎‏, ‏Subglottic secretion suctioning lead to reduction in VAP by relative risk (95%CI) of ‏‎0.167 (0.045–0.559)‎‏, p-‏value = 0.001. ‏Twenty eight patients didn’t show any sign, symptoms ‎or radiological features suggesting a ‎diagnosis of pneumonia while two patients developed ‎features of pneumonia (suggestive signs and ‎symptoms, radiological features and ‎positive culture of tracheal aspirate).‎ CONCLUSION: the use of endotracheal tube with subglottic ‎secretions suctioning can have a role in the prevention of VAP in mechanically ventilated patients.‎

Subglottic Secretion Drainage

2007 ◽  
Vol 18 (4) ◽  
pp. 366-379 ◽  
Author(s):  
Charlotte L. DePew ◽  
Mary S. McCarthy
Keyword(s):  
Endotracheal Tube ◽  
American Association ◽  
American Thoracic Society ◽  
Critical Care Nurses ◽  
Evidence Based ◽  
Ventilator Associated Pneumonia ◽  
Subglottic Secretion ◽  
Control And Prevention ◽  
Subglottic Secretion Drainage ◽  
Research Recommendations

Ventilator-associated pneumonia is a costly complication of hospitalization that lengthens intensive care unit and hospital stay, increasing morbidity and mortality. Among evidence-based measures to prevent ventilator-associated pneumonia is the use of a specialized endotracheal tube that aspirates subglottic secretions. Recommendations for subglottic aspiration are found in guidelines by the Centers for Disease Control and Prevention, American Association of Critical-Care Nurses, and the American Thoracic Society. The purpose of this article is to review the available evidence regarding the use of an endotracheal tube with a subglottic secretion aspiration port to prevent ventilator-associated pneumonia. Issues, cost, benefits, and research recommendations will also be discussed.

scholarly journals Association of interleukin-17A rs2275913 polymorphism with rheumatoid arthritis susceptibility in Sudanese population

2021 ◽  
Vol 9 ◽  
pp. 205031212110202
Author(s):  
Rgda Mohamed Osman ◽  
Mounkaila Noma ◽  
Abdallah Elssir Ahmed ◽  
Hanadi Abdelbagi ◽  
Rihab Ali Omer ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Confidence Interval ◽  
Statistical Tests ◽  
Demographic Data ◽  
Control Group ◽  
P Value ◽  
Case Group ◽  
Molecular Technique ◽  
Interleukin 17A ◽  
Significant Difference

Objectives: Rheumatoid arthritis is a chronic inflammatory autoimmune disease. This study aimed to determine the association of interleukin-17A-197G/A polymorphism with rheumatoid arthritis in Sudanese patients. Methods: A case–control study was conducted between March and December 2018. Clinical and demographic data of the study participants were collected and analyzed. Polymerase chain reaction restriction fragment length polymorphism molecular technique was done to investigate interleukin-17A-197G/A polymorphisms. All statistical tests were considered statistically significant when p < 0.05. Results: The study population included 266 participants aged between 1 and 85 years, with an average of 40 years, classified into 85 (31.2%) cases (mean age 48.5 ± 11.3 years), and 181 (68.8%) controls (mean age 35.3 ± 15.9 years). The interleukin-17A homozygote AA genotype was more frequent among the control group compared to the case group; 95 (52.5%) and 7 (8.2%), respectively. The homozygote GG and the heterozygote AG genotypes were proportionally not different among the cases and control groups; 13 (54.2%) and 11 (45.8%), and 65 (46.4%) and 75 (53.6%), respectively. According to the distribution of interleukin-17A genotypes, a statistically significant difference was observed among cases with the interleukin-17A AA and AG genotypes, p values 0.001 and 0.004, respectively. For the association interleukin-17A genotypes and family history a negatively significant association was reported (95% confidence interval, –0.219, p value = 0.001). There was also a negatively significant association of interleukin-17A genotypes and anti-cyclic citrullinated peptide (95% confidence interval, −0.141, p value = 0.002). Conclusion: This study is the first study in Sudan established the association between interleukin-17A-197G/A (rs2275913) polymorphisms and susceptibly to rheumatoid arthritis. These findings appeal for further research in Sudan to investigate the exact role of IL-17A in immunopathology and disease severity among Sudanese rheumatoid arthritis

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