Major article
Subglottic secretion drainage and continuous control of cuff pressure used together save health care costs

https://doi.org/10.1016/j.ajic.2014.06.028Get rights and content

Highlights

  • Subglottic secretion control reduced the incidence of respiratory infection.

  • Subglottic secretion control saved health care costs.

  • Subglottic secretion drainage with continuous control of cuff pressure is the best choice.

Background

Preventive strategies to reduce ventilator-associated respiratory infection (VARI) include the use of an endotracheal tube incorporating a lumen for subglottic secretion drainage (SSD) and a system for continuous control of endotracheal tube cuff pressure (CCCP). The health care costs associated with the combined use of these 2 measures aimed at preventing VARI are not known, however. The objective of this study was to determine whether the simultaneous use of these 2 preventive measures for VARI could save health care costs.

Methods

We performed a prospective observational study of patients who needed mechanical ventilation in an intensive care unit. The health care costs considered here included only the costs of the endotracheal tube, cuff control, and antimicrobials used to treat VARI.

Results

The study cohort comprised 656 patients, including 241 with intermittent control of cuff pressure and without SSD (standard group), 260 with CCCP and without SSD (CCCP group), 84 with intermittent control of cuff pressure and with SSD (SSD group), and 71 with CCCP and SSD (CCCP + SSD group). The incidence of VARI and health care costs were lower in the CCCP + SSD group compared with the standard, CCCP, and SSD groups.

Conclusions

The combined use of SSD and CCCP reduced the incidence of VARI and saved health care costs.

Section snippets

Study design

A prospective observational study with an incidental sample of 656 patients was performed at the 24-bed medical-surgical intensive care unit (ICU) of the University Hospital of the Canary Islands, a 650-bed tertiary hospital, over a 1-year period. The study was approved by the hospital's Institutional Ethics Review Board. Informed consent was obtained from all patients or legal guardians. The inclusion criterion was the need for mechanical ventilation.

VAP prevention measures

The following endotracheal tubes were used:

Results

Our study cohort comprised 656 patients, including 241 with intermittent control of cuff pressure and without SSD (standard group), 260 with continuous control of cuff pressure and without SSD (CCCP group), 84 with intermittent control of cuff pressure and with SSD (SSD group), and 71 with continuous control of cuff pressure and with SSD (CCCP + SSD group) (Table 1).

The incidence of VARI was lower in the CCCP + SSD group compared with the standard group (P < .001), CCCP group (P = .006), and

Discussion

To our knowledge, this is the first study to report that the combined use of an endotracheal tube with a lumen for SSD and a continuous cuff pressure control system can reduce health care costs. We found that the use of an endotracheal tube with a small-bore lumen for SSD exerted a protective effect against VARI, a finding consistent with the results of previous studies.7, 8, 9, 10

In addition, we found that the use of a CCCP system reduced the risk of VARI. This finding is in agreement with the

Conclusion

The combined use of subglottic secretion drainage and continuous control of endotracheal tube cuff pressure decreased the incidence of VARI and reduced health care costs in our study population.

References (27)

  • N. Bercault et al.

    Mortality rate attributable to ventilator-associated nosocomial pneumonia in an adult intensive care unit: a prospective case-control study

    Crit Care Med

    (2001)
  • D.K. Warren et al.

    Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center

    Crit Care Med

    (2003)
  • N. Safdar et al.

    Clinical and economic consequences of ventilator-associated pneumonia: a systematic review

    Crit Care Med

    (2005)
  • Cited by (0)

    Supported in part by grants from the Instituto de Salud Carlos III (I3SNS- INT-11-063 and I3SNS-INT-12-087) and the Fondo Europeo de Desarrollo Regional.

    Conflict of interest: None to report.

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