SSD(subglottic suction)減少VAP-multicenter study

減少42%VAP rate, 這一根管子要價多少?
這個study可以顯示出VAP的減少，但無法顯示出2nd endpoint(mortality, MV days, ICU stay的減少)
作者預期case number夠多，大約可減少ICU mortality 1-3%
划算否?


Intermittent Subglottic Suction to Prevent Ventilator-Associated Pneumonia?

In a randomized, nonblinded study, intermittent subglottic suction reduced the incidence of microbiologically confirmed VAP by 42%.

Ventilator-associated pneumonia (VAP) occurs in 9% to 27% of patients receiving mechanical ventilation in intensive care units (ICUs). Because the condition results in part from leakage of secretions around the endotracheal cuff, subglottic secretion drainage (SSD) using a specially designed endotracheal tube has been used to diminish this risk. However, previous studies of this strategy have produced conflicting results. Now, investigators in France, with partial support from the manufacturer of the endotracheal tube, have conducted a multicenter study to shed light on the issue.

A total of 333 adults who were admitted to the ICU and were expected to require mechanical ventilation for ≥48 hours were randomized to receive SSD or no SSD. Nurses and physicians were not blinded to the randomization.

Microbiologically confirmed VAP occurred less frequently in the SSD group — which received SSD a median of 18 times each day — than in the control group (14.8% vs. 25.6%; P=0.02; relative risk, 0.58). SSD was associated with significant reductions in both early-onset (<5 src="http://infectious-diseases.jwatch.org/math/ge.gif" alt="≥" border="0">5 days) VAP. Eleven occurrences of VAP were avoided for every 100 patients receiving SSD. Although the probability of remaining VAP free during mechanical ventilation was significantly higher in those receiving SSD, the duration of mechanical ventilation, the length of ICU stay, and the rate of hospital mortality were similar between groups.

Comment: These data confirm that the incidence of microbiologically confirmed VAP is reduced with SSD. Because the endotracheal tube required to perform SSD is more expensive than conventional tubes, an analysis comparing the cost of VAP treatment versus the cost of the endotracheal tube would have been of interest.

— Neil M. Ampel, MD

Published in Journal Watch Infectious Diseases October 27, 2010

Citation(s):

Lacherade J-C et al. Intermittent subglottic secretion drainage and ventilator-associated pneumonia: A multicenter trial. Am J Respir Crit Care Med 2010 Oct 1; 182:910.

https://docs.google.com/viewer?a=v&pid=explorer&chrome=true&srcid=0B278nGJMQBk7NWYwYzVhYzUtOTgyOC00YzRkLThiY2QtN2JlOWUxZDlkYWUw&hl=zh_TW


CASS(continuous aspiration of subglottic secretions)唯一可用之e-t tube -> Hi-Lo Evac
http://www.zapvap.com/hilo.aspx

VAP guideline summaries
https://docs.google.com/viewer?a=v&pid=explorer&chrome=true&srcid=0B278nGJMQBk7ZmQ3ZWJhNjQtMDkxNy00OTk4LWIxOTctNzlmMTg0ZjJjZDlj&hl=zh_TW

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