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A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
Published on: January 17, 2011
Airway colonisation in long-term mechanically ventilated patients. Effect of semi-recumbent position and continuous
Emmanuelle Girou1, Annie Buu-Hoi2, François Stephan3
1Infection Control Unit, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris , 51 avenue Mal de Lattre de Tassigny, 94010, Créteil, France. emmanuelle.girou@hmn.ap-hop-paris.fr.
Objective:
To evaluate the impact of continuous subglottic suctioning and semi-recumbent body position on bacterial colonisation of the lower respiratory tract.
Design:
A randomised controlled trial.
Setting:
The ten-bed medical ICU of a French university hospital.
Patients:
Critically ill patients expected to require mechanical ventilation for more than 5 days.
Interventions:
Patients were randomly assigned to receive either continuous suctioning of subglottic secretions and semi-recumbent body position or to receive standard care and supine position.
Measurements And Results:
Oropharyngeal and tracheal secretions were sampled daily and quantitatively cultured. All included patients were followed up from day 1 (intubation) to day 10, extubation or death. Ninety-seven samples of oropharynx and trachea were analysed (40 for the suctioning group and 57 for the control group). The median bacterial counts in trachea were 6.6 Log10 CFU/ml (interquartile range, IQR, 4.4-8.3) in patients who received continuous suctioning and 5.1 Log10 CFU/ml (IQR 3.6-5.5) in control patients. Most of the patients were colonised in the trachea after 1 day of mechanical ventilation (75% in the suctioning group, 80% in the control group). No significant difference was found in the daily bacterial counts in the oropharynx and in the trachea between the two groups of patients.
Conclusion:
Tracheal colonisation in long-term mechanically ventilated ICU patients was not modified by the use of continuous subglottic suctioning and semi-recumbent body position.
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