1016. A Prospective Pilot Study of Ventilator Associated Respiratory Infections (VARI) in Patients Intubated with an Endotracheal Tube with Intermittent Subglottic Secretions Drainage (SSD-ETT) Versus a Conventional Endotracheal Tube (C-ETT) 
Session: Poster Abstract Session: Diagnosing Pneumonia and Meningitis
Saturday, October 22, 2011
Room: Poster Hall B1
Background: VARI, which includes ventilator-associated tracheobronchitis (VAT) and pneumonia (VAP), is a common complication of mechanical ventilation. Data suggest that use of the SSD-ETT decreases early VAP. But the incidence of VAT and cost-effectiveness has not been evaluated. We conducted this study to evaluate the incidence of microbiologic VARI in patients with SDD-ETT versus a conventional ETT (C-ETT).

Methods: 188 medical and surgical ICU patients intubated for ≥ 48 hours were enrolled in the study. Daily quantitative endotracheal aspirates (Q-EA) cultures were obtained: 48 patients had the SSD-ETT with a special port for drainage of subglottic secretions (Mallinckrodt SealGuard Evac ETT) and 140 patients with the C-ETT tube (RUSCH). Serial Q-EA were analyzed. APACHE II scores, clinical signs of VARI  and chest radiographs were examined. The incident rates of VARI, microbiology, ventilator and intensive care unit  (ICU) day, hospital days and mortality were evaluated using Wilcoxon rank sum test and Fisher’s exact test.

Results: 51 (27%) patients met the clinical and microbiological (Q-EA >105cfu/ml) criteria for VARI; incidence was similar for the SSD-ETT and C-ETT groups (25% vs. 28%, p = 0.85). VARI rates of Staphylococcus aureus and Entererobactericeae were lower, but not statistically significant, in SSD-ETT group; VARI rates of methicilllin-resistant S. aureus (MRSA), Pseudomonas aeruginosa and Acinetobacter species  were similar in both groups. The daily bacterial colonization did not differ between SSD-ETT group and C-ET group (3rd day: 1.8 vs 2.2, P = 0.75; 4th day: 1.0 vs 1.7, P = 0.09).  The other outcomes — ventilator days, ICU days, hospital days and mortality — were not different between two groups.

Conclusion: The incidence of VARI rates was not different in the two study groups. There was a trend toward decreased airway colonization on 4th day of ventilation in the  SSD-ETT group but no difference in mortality. The benefit of the SSD-ETT in mechanically ventilated patients appears limited and the cost for the SSD-ETT tube is ~5-fold higher than the C-ETT. Based these data and the need to stock two different ETT types, we recommend caution before choosing the SSD-ETT for routine VAP prevention.


Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Akmal Sarwar, MD1, Jana Hudcova, MD2,3, Robin Ruthazer, MPH4, Yuxiu Lei, Ph.D5, Respiratory Care Staff6 and Donald Craven, MD, FIDSA5,7, (1)Pulmonary & Critical Care Medicine, Lahey Clinic, Burlington, MA, (2)Surgical Critical Care, Lahey Clinic, Burlington, MA, (3)Anaesthesia, Tufts Medical Center, Boston, MA, (4)Tufts Medical Center, Boston, MA, (5)Center for Infectious Disease & Prevention, Lahey Clinic, Burlington, MA, (6)Respiratory Care, Lahey Clinic, Burlington, MA, (7)Tufts University School of Medicine, Burlington, MA

Disclosures:

A. Sarwar, None

J. Hudcova, None

R. Ruthazer, None

Y. Lei, None

R. C. Staff, None

D. Craven, pfizer: Consultant, Investigator, Scientific Advisor and Speaker's Bureau, Consulting fee, Grant recipient and Speaker honorarium

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