Top

Intensive Care Medicine

Published in:

01-02-2004 | Original

Airway colonisation in long-term mechanically ventilated patients

Effect of semi-recumbent position and continuous subglottic suctioning

Authors: Emmanuelle Girou, Annie Buu-Hoi, François Stephan, Ana Novara, Laurent Gutmann, Michel Safar, Jean-Yves Fagon

Published in: Intensive Care Medicine | Issue 2/2004

Abstract

Objective

To evaluate the impact of continuous subglottic suctioning and semi-recumbent body position on bacterial colonisation of the lower respiratory tract.

Design

A randomised controlled trial.

Setting

The ten-bed medical ICU of a French university hospital.

Patients

Critically ill patients expected to require mechanical ventilation for more than 5 days.

Interventions

Patients were randomly assigned to receive either continuous suctioning of subglottic secretions and semi-recumbent body position or to receive standard care and supine position.

Measurements and results

Oropharyngeal and tracheal secretions were sampled daily and quantitatively cultured. All included patients were followed up from day 1 (intubation) to day 10, extubation or death. Ninety-seven samples of oropharynx and trachea were analysed (40 for the suctioning group and 57 for the control group). The median bacterial counts in trachea were 6.6 Log₁₀CFU/ml (interquartile range, IQR, 4.4–8.3) in patients who received continuous suctioning and 5.1 Log₁₀CFU/ml (IQR 3.6–5.5) in control patients. Most of the patients were colonised in the trachea after 1 day of mechanical ventilation (75% in the suctioning group, 80% in the control group). No significant difference was found in the daily bacterial counts in the oropharynx and in the trachea between the two groups of patients.

Conclusion

Tracheal colonisation in long-term mechanically ventilated ICU patients was not modified by the use of continuous subglottic suctioning and semi-recumbent body position.

Craven DE, Steger KA (1995) Epidemiology of nosocomial pneumonia. New perspectives on an old disease. Chest 108 (Suppl. 2):1S–16SCrossRef

Fagon JY (1997) Influence of pneumonia on the mortality of the critically ill. Curr Opin Crit Care 3:56–64CrossRef

American Thoracic Society (1996) Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy and preventive strategies. A consensus statement. Am J Respir Crit Care Med 153:1711–1725CrossRef

Tablan OC, Anderson LJ, Arden NH, Breiman RF, Butler JC, McNeil MM (1994) Guideline for prevention of nosocomial pneumonia. The Hospital Infection Control Practices Advisory Committee, Centers for Disease Control and Prevention. Infect Control Hosp Epidemiol 15:587–627CrossRef

Cook D, De Jonghe B, Brochard L, Brun-Buisson C (1998) Influence of airway management on ventilator-associated pneumonia. JAMA 279:781–787CrossRef

Kollef MH (1999) The prevention of ventilator-associated pneumonia. N Engl J Med 340:627–634CrossRef

Estes RJ, Meduri GU (1995) The pathogenesis of ventilator-associated pneumonia: I. Mechanisms of bacterial transcolonization and airway inoculation. Intensive Care Med 21:365–383CrossRef

Niederman MS, Craven DE (1997) Editorial response: Devising strategies for preventing nosocomial pneumonia—should we ignore the stomach? Clin Infect Dis 24:320–323CrossRef

Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogue S, Ferrer M (1999) Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet 354:1851–1858CrossRef

10.

Valles J, Artigas A, Rello J, Bonsoms N, Fontanals D, Blanch L, Fernandez R, Baigorri F, Mestre J (1995) Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia. Ann Intern Med 122:179–186CrossRef

11.

Mahul P, Auboyer C, Jospe R, Ros A, Guerin C, el Khouri Z, Galliez M, Dumont A, Gaudin O (1992) Prevention of nosocomial pneumonia in intubated patients: respective role of mechanical subglottic secretions drainage and stress ulcer prophylaxis. Intensive Care Med 18:20–25CrossRef

12.

Kollef MH, Skubas NJ, Sundt TM (1999) A randomized clinical trial of continuous aspiration of subglottic secretions in cardiac surgery patients. Chest 116:1339–1346CrossRef

13.

Smulders K, van der Hoeven H, Weers-Pothoff I, Vandenbroucke-Grauls C (2002) A randomized clinical trial of intermittent subglottic secretion drainage in patients receiving mechanical ventilation. Chest 121:858–862CrossRef

14.

Shorr AF, O’Malley PG (2001) Continuous subglottic suctioning for the prevention of ventilator-associated pneumonia. Potential economic implications. Chest 119:228–235CrossRef

15.

Stauffer JL (1994) Complications of translaryngeal intubation. In: Tobin MJ (ed) Principles and practice of mechanical ventilation. McGraw-Hill, New York, p 740

16.

Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829CrossRef

17.

Fagon JY, Chastre J, Novara A, Medioni P, Gibert C (1993) Characterization of intensive care unit patients using a model based on the presence or absence of organ dysfunctions and/or infection: the ODIN model. Intensive Care Med 19:137–144CrossRef

18.

Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81–84CrossRef

19.

Cullen DJ, Civetta JM, Briggs BA, Ferrara LC (1974) Therapeutic intervention scoring system: a method for quantitative comparison of patient care. Crit Care Med 2:57–61CrossRef

20.

Chastre J, Fagon JY, Soler P, Bornet M, Domart Y, Trouillet JL, Gibert C, Hance AJ (1988) Diagnosis of nosocomial bacterial pneumonia in intubated patients undergoing ventilation: comparison of the usefulness of bronchoalveolar lavage and the protected specimen brush. Am J Med 85:499–506CrossRef

21.

Wimberley N, Faling LJ, Bartlett JG (1979) A fiberoptic bronchoscopy technique to obtain uncontaminated lower airway secretions for bacterial culture. Am Rev Respir Dis 119:337–343PubMed

22.

Fagon JY, Chastre J, Hance AJ, Guiguet M, Trouillet JL, Domart Y, Pierre J, Gibert C (1988) Detection of nosocomial lung infection in ventilated patients. Use of a protected specimen brush and quantitative culture techniques in 147 patients. Am Rev Respir Dis 138:110–116CrossRef

23.

Lennette EH, Balows A, Hausler WJJ, Truland JP (1980) Manual of clinical microbiology. 3rd edn. American Society of Microbiology, Washington, DC

24.

Ewig S, Torres A, El-Ebiary M, Fabregas N, Hernandez C, Gonzalez J, Nicolas JM, Soto L (1999) Bacterial colonization patterns in mechanically ventilated patients with traumatic and medical head injury. Incidence, risk factors and association with ventilator-associated pneumonia. Am J Respir Crit Care Med 159:188–198CrossRef

25.

Zalacain R, Sobradillo V, Amilibia J, Barron J, Achotegui V, Pijoan JI, Llorente JL (1999) Predisposing factors to bacterial colonization in chronic obstructive pulmonary disease. Eur Respir J 3:343–348CrossRef

26.

Bonten MJM, Gaillard CA, van Tiel FH, Smeets HGW, van der Geest S, Stobberingh EE (1994) The stomach is not a source for colonization of the upper respiratory tract and pneumonia in ICU patients. Chest 105:878–884CrossRef

27.

Garrouste-Orgeas M, Chevret S, Arlet G, Marie O, Rouveau M, Popoff N, Schlemmer B (1997) Oropharyngeal or gastric colonization and nosocomial pneumonia in adult intensive care unit patients. Am J Respir Crit Care Med 56:1647–1655CrossRef

28.

Van Uffelen R, van Saene HKF, Fidler V, Löwenberg A (1984) Oropharyngeal flora as a source of bacteria colonizing the lower airways in patients on artificial ventilation. Intensive Care Med 10:233–237CrossRef

29.

De Latorre FJ, Pont T, Ferrer A, Rossello J, Palomar M, Planas M (1995) Pattern of tracheal colonization during mechanical ventilation. Am J Respir Crit Care Med 52:1028–1033

30.

Orozco-Levi M, Torres A, Ferrer M, Piera C, el-Ebiary M, de la Bellacasa JP, Rodriguez-Roisin R (1995) Semirecumbent position protects from pulmonary aspiration but not completely from gastroesophageal reflux in mechanically ventilated patients. Am J Respir Crit Care Med 152:1387–1390CrossRef

31.

McMullin JP, Cook DJ, Meade MO, Weaver BR, Letelier LM, Kahmamoui K, Higgins DA, Guyatt GH (2002) Clinical estimate of trunk position among mechanically ventilated patients. Intensive Care Med 28:304–309CrossRef

32.

Berra L, De Marchi L, Panigada M, Lewandowki R, Appleton J, Costello K, Villa F, Mahar R, Kolobow T (2003) Effects of continuous aspiration of subglottic secretions on tracheal integrity and bacterial colonization of the respiratory tract and role of tracheal tube orientation (abstract). International Conference of the American Thoracic Society, Seattle

33.

Miller RL, Cole RP (1996) Association between reduced cuff leak volume and postextubation stridor. Chest 110:1035–1040CrossRef

34.

Darmon JY, Rauss A, Dreyfuss D, Bleichner G, Elkharrat D, Schlemmer B, Tenaillon A, Brun-Buisson C, Huet Y (1992) Evaluation of risk factors for laryngeal edema after tracheal extubation in adults and its prevention by dexamethasone. Anesthesiology 77:245–251CrossRef

Title: Airway colonisation in long-term mechanically ventilated patients
Effect of semi-recumbent position and continuous subglottic suctioning
Authors: Emmanuelle Girou
Annie Buu-Hoi
François Stephan
Ana Novara
Laurent Gutmann
Michel Safar
Jean-Yves Fagon
Publication date: 01-02-2004
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 2/2004
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-003-2077-4

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Airway colonisation in long-term mechanically ventilated patients

Effect of semi-recumbent position and continuous subglottic suctioning

Abstract

Objective

Design

Setting

Patients

Interventions

Measurements and results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objective

Design

Setting

Patients

Interventions

Measurements and results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2004

Cooling heat stroke patients by available field measures

Changes in FiO2 affect PaO2 with minor alterations in cerebral concentration of oxygenated hemoglobin during liquid ventilation in healthy piglets

A puzzling electrocardiogram

Comment on “Changes in cerebral interstitial glycerol concentration in head injured patients; correlation with secondary events”

Clinical pulmonary infection score for ventilator-associated pneumonia: accuracy and inter-observer variability

Effects of C1 esterase inhibitor administration on intestinal functional capillary density, leukocyte adherence and mesenteric plasma extravasation during experimental endotoxemia