A randomized clinical trial of intermittent subglottic secretion drainage in patients receiving mechanical ventilation.

OBJECTIVE To study the effect of subglottic secretions drainage on the incidence of ventilator-associated pneumonia (VAP) in patients receiving mechanical ventilation. DESIGN A randomized clinical trial. SETTING A 12-bed general ICU. PATIENTS One hundred fifty patients with an expected duration of mechanical ventilation > 72 h were enrolled in the study. INTERVENTION Patients were randomly assigned to receive either an endotracheal tube for intermittent subglottic secretions drainage or a standard endotracheal tube. OUTCOME MEASUREMENTS Incidence of VAP, duration of mechanical ventilation, length of ICU stay, length of hospital stay, and mortality. RESULTS Seventy-five patients were randomized to subglottic secretion drainage, and 75 patients were randomized to the control group. The two groups were similar at the time of randomization with respect to demographic characteristics and severity of illness. VAP was seen in 3 patients (4%) receiving suction secretion drainage and in 12 patients (16%) in the control group (relative risk, 0.22; 95% confidence interval, 0.06 to 0.81; p = 0.014). The other outcome measures were not significantly different between the two groups. CONCLUSION Intermittent subglottic secretion drainage reduces the incidence of VAP in patients receiving mechanical ventilation.