Early Replacement of Conventional Endotracheal Tube with Endotracheal Tube with Subglottic Suction port for the New Intensive Care Patients; Preventive or Problematic against Ventilator Associated Events?

Masjedi Mansoor¹, Zand Farid², Sabetian Golnar³,
Maghsoudi Behzad⁴ and Savaie Mohsen⁵*

¹Assistant Professor of Anesthesiology and Critical Care Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
²Professor of Anesthesiology and Critical Care Medicine, Anesthesiology and Critical Care
Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
³Assistant Professor of Anesthesiology and Critical Care Medicine, Trauma Research Center,
Shiraz University of Medical Sciences, Shiraz, Iran.
⁴Associate Professor of Anesthesiology and Critical Care Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
⁵Anesthesiologist, Subspecialty Resident of Critical Care Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Abstract

Ventilator associated pneumonia may occur as a complication, in intubated patients under mechanical ventilation. In this study, we investigated the impact of early replacement of conventional endotracheal tube with an endotracheal tube with subglottic suction port on the incidence of ventilator associated events. We designed a randomized clinical trial, and enrolled 60 critical care trauma patients (31 in control group and 29 in intervention group). Conventional endotracheal tube was replaced with an endotracheal tube with subglottic suction port during first 12 hours of arrival in ICU in the intervention group. The incidence of ventilator associated conditions includinge ventilator associated pneumonia was measured, and compared between two groups. The incidence of ventilator associated conditions, infection-related ventilator associated complications, ventilator associated pneumonia according to center of disease control and prevention (CDC) criteria, and ventilator associated pneumonia according to clinical pulmonary infection score (CPIS) in control group versus intervention group were: 12.9% vs. 20.7% (P= 0.419), 3.23% vs. 13.8% (P= 0.419139), 54.8% vs. 44.8% (P= 0.438), and 34.5% vs. 32.3% (P= 0.855), respectively. Ventilator free days, intensive care unit length of stay and hospital costs in control group versus intervention group were: 10.26±10.26 days vs. 15.14±10.34 days (P= 0.062), 19.10±14.89 days vs. 16.70±12.37 days (P= 0.604), and 1057.64±1303.54$ vs. 1189.14±1072.72$ (P= 0.186), respectively. According to our study results, the replacement of conventional endotracheal tube with an endotracheal tube with subglottic
suction port, cannot be recommended as routine, because of undetermined its capability
to reduce ventilator associated events and hospital costs, and also concerns about some
risks such as airway loss and pulmonary aspiration. Further investigations are
recommended.

Keywords: Intensive care unit, Trauma, Ventilator associated pneumonia, Endotracheal intubation.