EFFECT OF INTERMITTENT SUBGLOTTIC SECRETION DRAINAGE VS STANDARD ENDOTRACHEAL TUBE ON THE INCIDENCE OF VAP IN INTENSIVE CARE UNITS.

When a patient is mechanically ventilated, the invasive ventilatory support is provided via either a tracheostomy tube or an endotracheal tube 1 .The endotracheal tube (ET) bypasses the natural cough mechanism which helps to avoid aspiration of upper-airway secretions.These secretions then pool above the ET cuff and eventually can cause microaspiration and thus pneumonia 2 which is known as Ventilator-associated pneumonia (VAP).VAP is the most frequently acquired infection by patients admitted in intensive care units (ICUs) that develops 48 hours or longer after mechanical ventilation.IDSA and ATS defines VAP as pneumonia that occurs >48 hours after the endotracheal intubation.3 It results from the invasion of the lower respiratory tract and lung parenchyma by microorganisms.Intubation compromises the integrity of the oropharynx and trachea and allows oral and gastric secretions to enter the lower airways 4 .VAP is associated with substantial morbidity and costs.VAP is a complication in as many as 28% of patients who receive mechanical ventilation.The incidence of VAP increases with the duration of mechanical ventilation.4 The subglottic secretion drainage is also one of the few newly suggested preventive strategies for prevention of VAP in intubated patients.Endotracheal tubes with subglottic secretion drainage (incorporating a suction port above the cuff) have been shown to reduce the incidence of VAP by 50% 5,6 but still it is not in common practice in ICUs in Indian settings.As this study assess and compare the effect of intermittent subglottic secretions drainage (ISSD) and standard endotracheal tube (SET) on the incidence of VAP.The evidence thus generated from this study clearly help to select the effective ET that will help in reduction of VAP. Methods:-The study was conducted in selected Intensive Care Units (ICUs) of a tertiary care hospital.ICUs included medicine ICU, surgery ICU, neurosurgery ICU, pulmonary Critical Care Unit, trauma ICU, stroke ICU and emergency ICUs.The ICUs have 24-hours intensivist coverage.Routine nursing care was given to the admitted patients.VAP prevention protocol was being followed as a part of routine care.This observational (comparative) study was performed in a 1326 bedded tertiary care hospital having 111 bedded ICUs capacity in India, from September 2014