Does subglottic secretion drainage prevent ventilator-associated pneumonia

AIM: To compare the incidence of ventilator-associated pneumonia (VAP) in patients who were admitted to the intensive care unit (ICU) for reasons other than pneumonia and followed up under mechanical ventilation either with standard endotracheal tubes or endotracheal tubes with subglottic secretion drainage (SSD). MATERIALS AND METHODS: Patients who were admitted to the ICU between April 2012 and January 2013 were prospectively and sequentially randomized to standard endotracheal and SSD intubation groups. Patients with pulmonary infection at ICU admission were excluded. Pulmonary imaging, blood, and sputum cultures were routinely screened, and pleural fluid and bronchial lavage examinations were done on demand. RESULTS: Mean age, gender distribution, APACHE II scores, duration of mechanical ventilation, and follow-up of patients with standard (n = 30) and SSD (n = 12) intubation tubes were similar; 71 10.4 versus 64.4 13.9 years (P 0.05), male/female 18/12 versus 9/3 (P 0.05), APACHE II scores 20.2 3.8 versus 17.0 3.8 (P = 0.02), 15.9 11.5 versus 11.0 8.1 days (P 0.05), and 18.0 12.4 versus 15.5 12.2 days (P 0.05), respectively. The incidence of VAP was similar in both groups (36.7% vs. 33.3%, P 0.05, in standard vs. SSD groups, respectively). The mortality rate was higher in the standard intubation group, but the difference was not statistically significant (70% vs. 41%, P 0.05). CONCLUSION: Compared to standard endotracheal intubation, intubation with SSD tubes was not associated with an improvement in the duration of mechanical ventilation, length of stay in the ICU, incidence of VAP, and mortality rate. Due to the limited number of patients included in this study, the results have to be confirmed in larger studies on more patients.