Subglottic secretions drainage and ventilator-associated pneumonia

Abstract

Drainage of subglottic secretions is one of the recommended interventions for prevention of ventilatorassociated pneumonia (VAP) with a high level of evidence, especially regarding early-onset pneumonia. All metaanalysis found that the use of subglottic secretions drainage reduces VAP occurrence with a relative risk reduction of 45% and improves clinical outcomes including duration of mechanical ventilation or length of intensive care unit (ICU) stay despite no beneficial effect on ICU or hospital mortality. Contrasting with these data, implementation of subglottic secretions drainage in the ICU remains not widespread. Several explanations could be suggested: doubts on the harmlessness of the use of subglottic secretions drainage, lack of gold standard to perform the drainage, high variability in the volume of secretions suctioned among patients and, for each patient during the period of mechanical ventilation, initial over-cost of specific endotracheal tubes, and availability of theses devices in the services involved in patent intubation before ICU admission.