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A Prospective Randomized Trial of Tapered-Cuff Endotracheal Tubes With Intermittent Subglottic Suctioning in Preventing Ventilator-Associated Pneumonia in Critically Ill Patients Publisher Pubmed



Mahmoodpoor A1 ; Hamishehkar H2 ; Hamidi M1 ; Shadvar K1 ; Sanaie S3 ; Golzari SE1 ; Khan ZH4 ; Nader ND5
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Authors Affiliations
  1. 1. Department of Anesthesiology and Critical Care Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
  2. 2. Department of Clinical Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
  3. 3. Tuberculosis and Lung Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
  4. 4. Department of Anesthesiology and Critical Care Medicine, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Department of Anesthesiology 252 Farber Hall, State University of New York at Buffalo, 3435 Main St, Buffalo, 14214, NY, United States

Source: Journal of Critical Care Published:2017


Abstract

Background 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. Methods 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. Results 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). Conclusion 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. © 2016
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