Efficacy of continuous versus intermittent subglottic secretion drainage in preventing ventilator-associated pneumonia in patients requiring mechanical ventilation: A single-center randomized controlled trial

// Hiroko Fujimoto 1, 2 , Osamu Yamaguchi 1, 2 , Hajime Hayami 1 , Mika Shimosaka 1 , Sayaka Tsuboi 1 , Mitsunori Sato 1 , Shigeo Takebayashi 3 , Satoshi Morita 4 , Mari Saito 4 , Takahisa Goto 2 and Kiyoyasu Kurahashi 5 1 Division of Critical Care, Yokohama City University Medical Center, Minami-ku, Yokohama, Kanagawa 232-0024, Japan 2 Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan 3 Radiation Department, Yokohama City University Medical Center, Minami-ku, Yokohama, Kanagawa 232-0024, Japan 4 Department of Biostatistics and Epidemiology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan 5 Department of Anesthesiology and Intensive Care Medicine, International University of Health and Welfare, School of Medicine, Narita, Chiba 286-8686, Japan Correspondence to: Kiyoyasu Kurahashi, email: kiyok@iuhw.ac.jp Keywords: ventilator-associated pneumonia; subglottic secretion drainage; length of mechanical ventilation Received: October 26, 2017      Accepted: February 24, 2018      Published: March 23, 2018 ABSTRACT Objective: Aspiration of subglottic secretion is a widely used intervention to prevent ventilator-associated pneumonia (VAP). This study aimed to compare the efficacy of continuous and intermittent subglottic secretion drainage (SSD) in preventing VAP. Methods: A single-center randomized controlled trial was conducted on adult postoperative patients who were expected to undergo mechanical ventilation for more than 48 hours. Primary outcome measure was incidence of VAP and secondary outcome measures were length of mechanical ventilation and intensive-care unit (ICU) stay. Results: Fifty-nine patients received continuous SSD, while 60 patients received intermittent SSD. Of these 119 patients, 88 (74%) were excluded and 15 and 16 patients were allocated to receive continuous and intermittent SSD, respectively. VAP was detected in 4 (26.7%) and 7 (43.8%) patients in the continuous and intermittent groups, respectively, (p=0.320). The length of mechanical ventilation was significantly shorter (p=0.034) in the continuous group (99.5±47.1 h) than in the intermittent group (159.9±94.5 h). The length of ICU stay was also shorter (p=0.0097) in the continuous group (6.3±2.1 days) than the intermittent group (9.8±4.8 days). Conclusions: Although continuous SSD did not reduce the incidence of VAP, it reduced the length of mechanical ventilation and ICU stay when compared to intermittent SSD.