Effectiveness of subglottic suctioning in the prevention of ventilator associated pneumonia

Ventilator-associated pneumonia (VAP) is the leading healthcare-acquired infection among ventilated patients in intensive care units (ICU). VAP is a serious patient complication that results in increased hospital length of stay, cost, morbidity, and mortality. The accumulation of subglottic secretions above the endotracheal tube (ETT) cuff increases the risk of VAP, as these secretions may leak around the cuff of the ETT resulting in aspiration and an increased risk for infection. An in depth literature review was done to determine the effectiveness of subglottic secretion aspiration (by means of specialized ETT tubes with intrinsic suction lumens) in decreasing the incidence rate of VAP. Evidenced-based data were gathered from the CINAHL Plus with Full Text, PubMed, and Cochrane Database of Systematic Reviews databases for this review. VAP guidelines recommend subglottic secretion aspiration as a means to prevent its occurrence. However, important variables such as suction pressure, frequency, secretion viscosity, and ETT cuff pressure and volume need to be considered. The interaction among these variables determines the effectiveness of subglottic secretion removal. The goal of this review was to highlight these interactions and provide evidenced-based information for critical care nurses to expand their understanding of the dynamics involved in subglottic secretion aspiration and how to efficiently use this practice to prevent VAP