Does subglottic secretion drainage prevent ventilator‑associated pneumonia?

Aim: To compare the incidences of ventilator associated pneumonia (VAP) in patients who were admitted into the intensive care unit (ICU) due to causes other than pneumonia and followed up under mechanical ventilation either with standard endotracheal intubation or endotracheal tubes with subglottic secretion drainage (SSD) function.
Methods: Patients who were admitted to the ICU between April 2012 and January 2013 were prospectively and sequentially randomized to standard endotracheal and SSD intubation groups. Patients with pulmonary infection at ICU admission were excluded. Pulmonary imaging, blood and sputum cultures were routinely screened and pleural fluid and bronchial lavage examinations were done on demand.
Results: Mean age, gender distribution, APACHE II scores, duration under mechanical ventilation and follow up of patients with standard (n 30) and SSD (n 12) intubation tubes were similar;71±10.4 vs 64.4±13.9 years (p >0.05), M/F 18/12 vs 9/3 (p >0.05), APACHE II scores 20.2±3.8 vs 17.0±3.8 (p 0.02), 15.9±11.5 vs 11.0±8.1 days (p >0.05) and 18.0±12.4 vs 15.5±12.2 days (p >0.05), respectively. The incidence of VAP was similar in both groups (36.7% vs 33.3%, p >0.05, in standard vs SSD groups, respectively). The mortality rate was higher in the standard intubation group, but the difference was not statistically significant (70% vs 41%, p>0,05).
Conclusion: As compared to standard endotracheal intubation, intubation with SSD tubes was not associated with improvement in any of duration under mechanical ventilation, duration in ICU, incidence of VAP and mortality. Limited number of patients requires that these findings should be confirmed with a larger study.