Air-impingement Manipulation to Clear Subglottic Secretion to Prevent VAP in Prolonged Intubated Patients

Air-impingement Manipulation to Clear Subglottic Secretion to Prevent VAP in Prolonged Intubated Patients

Air-impingement Manipulation to Clear Subglottic Secretion to Prevent Ventilator Associated Pneumonia in Prolonged Intubated Patients：a Randomized Controlled Trial

Ventilator-associated pneumonia (VAP) is the most frequent infection occurring in patients who are admitted to the ICU. The accumulation of respiratory secretions in the subglottic space is a well-proven cause of VAP. Investigators invented a manual method with high-flow air produced by resuscitator to impinge secretion from the subglottic space to oral cavity. Investigators want to compare it with conventional method which uses a special intubation tube with an independent dorsal lumen to suction subglottic secretion.

Ventilator-associated pneumonia (VAP) is the most frequent infection occurring in patients who are admitted to the ICU. The accumulation of respiratory secretions in the subglottic space is a well-proven cause of VAP. Therefore, prevention should include the aspiration of secretions from the subglottic space. Investigators invented a manual method with high-flow air produced by resuscitator to impinge secretion from the subglottic space to oral cavity. This method has been granted as a patent by Chinese national intellectual property patent office, it has been used in investigators' daily work for more than 10 years and more than 20 Chinese ICUs have used it everyday. Investigators want to compare it with conventional method which uses a special intubation tube with an independent dorsal lumen to suction subglottic secretion.

Participants will be followed for the duration of invasive ventilation, an expected average of 7-10 days

Inclusion Criteria:Should meet all the criteria: Intubation less than 24 hours before admitting respiratory intensive care unit; Anticipated intubation for more than 72 hours; Anticipated survival time is more than 2 weeks Exclusion Criteria:Meet any of these criteria: PEEP≥10cmH2O or FiO2≥0.8; unstable hemodynamics; severe bulla and pneumothorax; enrolled in other study; cuff leak test is positive.

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Prevention of ventilator-associated pneumonia and ventilator-associated conditions: a randomized controlled trial with subglottic secretion suctioning.

http://www-ncbi-nlm-nih-gov.proxy1.lib.uwo.ca/pubmed/?term=Intermittent+subglottic+secretion+drainage+may+cause+tracheal+damage+in+patients+with+few+oropharyngeal+secretions

Intermittent subglottic secretion drainage may cause tracheal damage in patients with few oropharyngeal secretions.

http://www-ncbi-nlm-nih-gov.proxy1.lib.uwo.ca/pubmed/?term=Influence+of+an+endotracheal+tube+with+polyurethane+cuff+and+subglottic+secretion+drainage+on+pneumonia.

Influence of an endotracheal tube with polyurethane cuff and subglottic secretion drainage on pneumonia.

http://www-ncbi-nlm-nih-gov.proxy1.lib.uwo.ca/pubmed/?term=Effect+of+tow+methods+of+subglottic+secretion+drainage+on+the+incidence+of+ventilator-associated+pneumonia.

Effect of two methods of subglottic secretion drainage on the incidence of ventilator-associated pneumonia

http://www-ncbi-nlm-nih-gov.proxy1.lib.uwo.ca/pubmed/?term=Continuous+aspiration+of+subglottic+secretions+in+the+prevention+of+ventilator-associated+pneumonia+in+the+postoperative+period+of+major+heart+surgery.

Continuous aspiration of subglottic secretions in the prevention of ventilator-associated pneumonia in the postoperative period of major heart surgery.