Saline instillation before tracheal suctioning decreases the incidence of ventilator-associated pneumonia*
- 1 January 2009
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 37 (1), 32-38
- https://doi.org/10.1097/ccm.0b013e3181930026
Abstract
To compare the incidence of ventilator-associated pneumonia (VAP) with or without isotonic saline instillation before tracheal suctioning. As a secondary objective, we compared the incidence of endotracheal tube occlusion and atelectasis.Randomized clinical trial.The study was conducted in a medical surgical intensive care unit of an oncologic hospital. We selected consecutive patients needing mechanical ventilation for >72 hrs. Patients were allocated into two groups: a saline group that received instillation of 8 mL of saline before tracheal suctioning and a control group which did not. VAP was diagnosed based on clinical suspicion and confirmed by bronchoalveolar lavage quantitative culture. The incidence of atelectasis on daily chest radiography and endotracheal tube occlusions were recorded. The sample size was calculated to a power of 80% and a type I error probability of 5%.One hundred thirty patients were assigned to the saline group and 132 to the control group. The baseline demographic variables were similar between groups. The rate of clinically suspected VAP was similar in both groups. The incidence of microbiological proven VAP was significantly lower in the saline group (23.5% x 10.8%; p = 0.008) (incidence density/1.000 days of ventilation 21.22 x 9.62; p < 0.01). Using the Kaplan-Meier curve analysis, the proportion of patients remaining without VAP was higher in the saline group (p = 0.02, log-rank test). The relative risk reduction of VAP in the saline instillation group was 54% (95% confidence interval, 18%-74%) and the number needed to treat was eight (95% confidence interval, 5-27). The incidence of atelectases and endotracheal tube occlusion were similar between groups.Instillation of isotonic saline before tracheal suctioning decreases the incidence of microbiological proven VAP.Keywords
This publication has 32 references indexed in Scilit:
- Clinical and economic consequences of ventilator-associated pneumonia: A systematic reviewCritical Care Medicine, 2005
- Mechanical effects of airway humidification devices in difficult to wean patients*Critical Care Medicine, 2003
- Clinical diagnosis of ventilator associated pneumonia revisited: comparative validation using immediate post-mortem lung biopsiesThorax, 1999
- Implications of endotracheal tube biofilm for ventilator-associated pneumoniaIntensive Care Medicine, 1999
- Incidence of and Risk Factors for Ventilator-Associated Pneumonia in Critically Ill PatientsAnnals of Internal Medicine, 1998
- Mechanical Ventilation with or without Daily Changes of In-Line Suction CathetersAmerican Journal of Respiratory and Critical Care Medicine, 1997
- The Prevalence of Nosocomial Infection in Intensive Care Units in EuropeJAMA, 1995
- Mechanical Ventilation with or without 7-Day Circuit ChangesAnnals of Internal Medicine, 1995
- Continuous Aspiration of Subglottic Secretions in Preventing Ventilator-Associated PneumoniaAnnals of Internal Medicine, 1995
- Nosocomial pulmonary infectionCritical Care Medicine, 1986