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Subglottic suction frequency and adverse ventilator-associated events during critical illness
Hatem O Abdallah1, Melanie F Weingart2, Risa Fuller3
1Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Infection Control and Hospital Epidemiology
|January 11, 2021
Summary
Increased sputum production, indicated by subglottic suction frequency, precedes ventilator-associated events (VAEs). This marker may help predict VAE risk but doesn't distinguish infection-associated VAEs.
Area of Science:
- Critical Care Medicine
- Pulmonary Medicine
- Infectious Disease
Background:
- Mechanical ventilation is crucial for respiratory failure but carries risks like ventilator-associated events (VAEs).
- Ventilator-associated events (VAEs) can be complex, sometimes involving infection, and their prediction remains a challenge.
- Subglottic secretions are a key indicator of patient status during mechanical ventilation.
Purpose of the Study:
- To investigate the relationship between sputum production, measured by subglottic suction frequency, and the occurrence of VAEs.
- To determine if subglottic suction frequency can differentiate between infection-associated VAEs and VAEs without infection.
- To assess the potential of subglottic suction frequency as an early warning marker for VAEs.
Main Methods:
- A case-crossover study design was employed, analyzing 848 pre-VAE days across 87 patients.
- Sputum production was quantified using the daily frequency of as-needed subglottic suctioning.
- Ventilator-associated events (VAEs) and their association with infection were defined using CDC surveillance criteria.
Main Results:
- A statistically significant increase in subglottic suction frequency was observed in the period immediately preceding a VAE compared to earlier periods.
- The frequency of subglottic suctioning was higher before VAE onset, suggesting a link between increased sputum production and VAE risk.
- Subglottic suction frequency did not effectively discriminate between VAEs with and without associated infection.
Conclusions:
- Subglottic suction frequency shows promise as a marker for increased sputum quantity and is associated with an elevated risk of VAEs.
- While a valuable indicator, the findings necessitate validation in diverse populations of mechanically ventilated patients and across various intensive care settings.
- Further research is warranted to refine the utility of subglottic suction frequency in VAE prediction and management.
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