Predicting Which Patients will Likely Benefit from Subglottic Secretion Drainage Endotracheal Tubes: A Retrospective Study

• Published in: The Journal of emergency medicine Vol. 50; no. 3; pp. 385 - 393
• Main Authors: Mareiniss, Darren P., MD, Xu, Tim, MPP, Pham, Julius Cuong, MD, PhD, Hsieh, Yu-Hsiang, PhD, Zhao, Jiawei, Nguyen, Christopher, Nguyen, Michael, Winters, Bradford, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2016
• Subjects: Adolescent; Adult; Aged; Drainage - methods; Emergency; Female; Glottis; Humans; intubation; Intubation, Intratracheal - methods; Intubation, Intratracheal - statistics & numerical data; Male; Middle Aged; Pneumonia, Ventilator-Associated - prevention & control; prevention; Retrospective Studies; subglottic secretion drainage endotracheal tubes; Time Factors; VAP; ventilator-associated pneumonia; Young Adult; ventilator-associated pneumonia; intubation; VAP; subglottic secretion drainage endotracheal tubes; prevention
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2015.10.039

Abstract Background Subglottic secretion drainage endotracheal tubes (SSD ETTs) have been shown to decrease ventilator-associated pneumonia and are recommended for patients intubated > 48 h or 72 h. However, it is difficult to determine which patients will be intubated > 48 h or 72 h at the time of intubation. Objective We attempted to determine which patient characteristics were associated with intubations ≥ 48 h or 72 h in order to guide proper placement of SSD ETTs. Methods The medical records of 2,159 ventilated patients at a single institution were retrospectively reviewed for intubation duration, age, sex, race, body mass index, weight, intubation reason, whether the intubation was emergent, operative status, intensive care unit (ICU) diagnosis, intubation location, ICU location, comorbidities (e.g., congestive heart failure, chronic obstructive pulmonary disorder, coronary artery disease, dementia, and liver disease), acute kidney injury (AKI), and chronic renal injury. A multivariate regression analysis was then performed with all reliable data. Results The following were associated with intubation ≥ 48 h: neuroscience critical care unit (NCCU) admission (risk ratio [RR] = 1.85; 95% confidence interval [CI] 1.34–2.56), emergent intubation (RR = 1.97; 95% 1.28–3.03), comorbid dementia (RR = 2.31; 95% 1.28–4.18), nonoperative intubation (RR = 1.77; 95% 1.28–4.18), and AKI (RR = 3.32; 95% 2.56–4.3). The following were independently associated with intubation ≥ 72 h: NCCU admission (RR = 2.2; 95 CI 1.57–3.08), nonoperative intubation (RR = 3.38; 95% CI 2.63–4.35), comorbid dementia (RR = 3.03; 95% CI 1.67–5.48), and AKI (RR = 3.11; 95% CI 2.38–4.07). Conclusion Nonoperative intubation, emergent intubation, history of dementia, admission to NCCU and AKI all appear to be independently associated with increased RRs for either ≥ 48 h or 72 h of ventilation.