Efficacy of Intermittent and Continuous Subglottic Secretion Drainage in Ventilator-Associated Pneumonia Reduction among Critically Ill Ventilated Patients: An Integrative Review
Journal Title: Saudi Journal of Medical and Pharmaceutical Sciences - Year 2017, Vol 3, Issue 5
Abstract
Abstract: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in critical care settings and affects between 9%-27% of mechanically ventilated patients for more than 48 or 72 hours. One of the strategies that reduce the VAP incidence is subglottic secretion drainage (SSD) through a lumen attached to a specialised endotracheal tube.This integrative review aims to investigate the efficacy of intermittent and continuous SSD in reducing VAP among critically ill ventilated patients. A systematic electronic search was conducted via CINAHL, PUBMED, MEDLINE and COCHRANE using the key terms. A manual search was also conducted through the references of retrieved studies, Scopus, and Google Scholar. Sixteen relevant primary articles were identified; twelve studies were conducted on general ICU populations examining intermittent subglottic drainage (ISD) and continuous aspiration of subglottic secretions (CASS) while four other studies were undertaken in cardiothoracic ICUs investigating CASS. No studies were found concerning the efficacy of ISD in this setting. Current evidence has revealed that ISD and CASS appear to be effective in general ICU settings while CASS did show significant reduction among the cardiothoracic ICU population. It was found that ISD appears to be safer in terms of tracheal damage despite the concerns of secretion pooling. This integrative review concluded that ISD and CASS appears to be effective methods in reducing VAP incidence among general ICU populations. Further research is needed to investigate both methods among cardiothoracic patients. A large randomised controlled trial is also required to compare the two settings and to determine the optimal frequency and suction pressure that could minimise complications. Keywords: Subglottic secretion drainage, ventilator-associated pneumonia, critically ill ventilated patients
Authors and Affiliations
Abdulmohsen Mohammed Folos, Mohammed Ageel Ahmed, Jubran Ali Sahli, Bander Mohammed Gohal, Ahmed Atyah Najmi, Ibrahim Mohammed Muallim, Ali Mohammed Abu Tawil
Keywords
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