Ventilator-associated pneumonia (VAP) is one of the most important hospital infections in hospitalized patients, which is associated with increased mortality and patient costs. The tracheal tube itself seems to be a major risk factor for VAP. Contaminated secretions pass through the endotracheal tube and reach the lungs. Also, bacteria form a bacterial biofilm on the tracheal tube and are transferred from there to the lungs. Different tracheal tube designs have been produced to overcome these cases. The purpose of this study is to investigate the effect of an Evac tracheal tube covered with antibiotics and normal on the incidence of pneumonia caused by the ventilator. Research method: 180 patients were randomly intubated in three groups of 60 people with three types of tracheal tubes, Evac and Bactiguard. Clinical examinations, endotracheal tube aspiration culture, and chest radiography were obtained from the patients and the incidence of VAP was calculated based on the CPIS standard. The relationship between the type of endotracheal tube and the incidence of VAP and the length of stay in the intensive care unit (ICU) and being discharged alive from the ICU were investigated. Findings and conclusions: The average incidence of VAP for the group of patients intubated with a conventional tracheal tube was 50%, EVAC was 45% and Bactiguard was 40%. The results showed that there is no significant relationship between the incidence of ventilator-induced pneumonia and the type of tracheal tube. The incidence of ventilator-induced pneumonia was not significantly reduced by suctioning subglottic secretions and Bactiguard tracheal tubes. It seems that using one method alone is not effective in reducing ventilator-induced pneumonia.
References
[1]
Weinstein, R.A., Bonten, M.J., Kollef, M.H. and Hall, J.B. (2004) Risk Factors for Ventilator-Associated Pneumonia: From Epidemiology to Patient Management. Clinical Infectious Diseases, 38, 1141-1149. https://doi.org/10.1086/383039
[2]
Sanaie, S., Rahnemayan, S., Azizi, S., Saghaleini, S.H., Ghamari, A.A., Ghojazadeh, M. and Mahmoodpoor, A. (2022) Comparison of Subglottic vs. Non-Subglottic Secretion Drainage in Prevention of Ventilator Associated Pneumonia: A Systematic Review and Meta-Analysis. Trends in Anaesthesia and Critical Care, 43, 23-29. https://doi.org/10.1016/j.tacc.2022.02.002
[3]
Mahmoodpoor, A., Hamishehkar, H., Hamidi, M., Shadvar, K., Sanaie, S., Golzari, S.E., Khan, Z.H. and Nader, N.D. (2017) A Prospective Randomized Trial of Tapered-Cuff Endotracheal Tubes with Intermittent Subglottic Suctioning in Preventing Ventilator-Associated Pneumonia in Critically Ill Patients. Journal of Critical Care, 38, 152-156. https://doi.org/10.1016/j.jcrc.2016.11.007
[4]
Saito, M., Maruyama, K., Mihara, T., Hoshijima, H., Hirabayashi, G. and Andoh, T. (2021) Comparison of Polyurethane Tracheal Tube Cuffs and Conventional Polyvinyl Chloride Tube Cuff for Prevention of Ventilator-Associated Pneumonia: A Systematic Review with Meta-Analysis. Medicine, 100, e24906. https://doi.org/10.1097/MD.0000000000024906
[5]
Alves, D., Grainha, T., Pereira, M.O. and Lopes, S.P. (2023) Antimicrobial Materials for Endotracheal Tubes: A Review on the Last Two Decades of Technological Progress. Acta Biomaterialia, 158, 32-55. https://doi.org/10.1016/j.actbio.2023.01.001
[6]
Ghoochani Khorasani, A., Shadnia, S., Mashayekhian, M., Rahimi, M. and Aghabiklooei, A. (2016) Efficacy of Hi-Lo Evac Endotracheal Tube in Prevention of Ventilator-Associated Pneumonia in Mechanically Ventilated Poisoned Patients. Scientifica, 2016, Article ID: 4901026. https://doi.org/10.1155/2016/4901026
[7]
Deem, S., Yanez, D., Sissons-Ross, L., Elrod Broeckel, J.A., Daniel, S. and Treggiari, M. (2016) Randomized Pilot Trial of Two Modified Endotracheal Tubes to Prevent Ventilator-Associated Pneumonia. Annals of the American Thoracic Society, 13, 72-80. https://doi.org/10.1513/AnnalsATS.201506-346OC
[8]
Hadda, V., Khilnani, G.C., Dubey, G., Nallan, R., Kumar, G. and Guleria, R. (2014) Impact of Ventilator Associated Pneumonia on Outcome in Patients with Chronic Obstructive Pulmonary Disease Exacerbation. Lung India: Official Organ of Indian Chest Society, 31, 4-8. https://doi.org/10.4103/0970-2113.125886
[9]
Kalanuria, A.A., Zai, W. and Mirski, M. (2014) Ventilator-Associated Pneumonia in the ICU. Critical Care, 18, Article No. 208. https://doi.org/10.1186/cc13775
[10]
Bekaert, M., Timsit, J.-F., Vansteelandt, S., Depuydt, P., Vésin, A., Garrouste-Orgeas, M., Decruyenaere, J., Clec’h, C., Azoulay, E. and Benoit, D. (2011) Attributable Mortality of Ventilator-Associated Pneumonia: A Reappraisal Using Causal Analysis. American Journal of Respiratory and Critical Care Medicine, 184, 1133-1139. https://doi.org/10.1164/rccm.201105-0867OC
[11]
Mahmoodpoor, A., Sanaie, S., Parthvi, R., Shadvar, K., Hamishekar, H., Iranpour, A., Nuri, H., Rahnemayan, S. and Nader, N.D. (2020) A Clinical Trial of Silver-Coated and Tapered Cuff plus Supraglottic Suctioning Endotracheal Tubes in Preventing Ventilator-Associated Pneumonia. Journal of Critical Care, 56, 171-176. https://doi.org/10.1016/j.jcrc.2019.12.024
[12]
Hubbard, J.L., Veneman, W.L., Dirks, R.C., Davis, J.W. and Kaups, K.L. (2016) Use of Endotracheal Tubes with Subglottic Secretion Drainage Reduces Ventilator-Associated Pneumonia in Trauma Patients. Journal of Trauma and Acute Care Surgery, 80, 218-222. https://doi.org/10.1097/TA.0000000000000927
[13]
Rello, J., Kollef, M., Diaz, E., Sandiumenge, A., Del Castillo, Y., Corbella, X. and Zachskorn, R. (2006) Reduced Burden of Bacterial Airway Colonization with a Novel Silver-Coated Endotracheal Tube in a Randomized Multiple-Center Feasibility Study. Critical Care Medicine, 34, 2766-2772. https://doi.org/10.1097/01.CCM.0000242154.49632.B0
[14]
Marjanovic, N., Boisson, M., Asehnoune, K., Foucrier, A., Lasocki, S., Ichai, C., Leone, M., Pottecher, J., Lefrant, J.-Y. and Falcon, D. (2021) Continuous Pneumatic Regulation of Tracheal Cuff Pressure to Decrease Ventilator-Associated Pneumonia in Trauma Patients Who Were Mechanically Ventilated: The AGATE Multicenter Randomized Controlled Study. Chest, 160, 499-508. https://doi.org/10.1016/j.chest.2021.03.007
[15]
Fernandez, J.F., Levine, S.M. and Restrepo, M.I. (2012) Technologic Advances in Endotracheal Tubes for Prevention of Ventilator-Associated Pneumonia. Chest, 142, 231-238. https://doi.org/10.1378/chest.11-2420
[16]
Dezfulian, C., Shojania, K., Collard, H.R., Kim, H.M., Matthay, M.A. and Saint, S. (2005) Subglottic Secretion Drainage for Preventing Ventilator-Associated Pneumonia: A Meta-Analysis. The American Journal of Medicine, 118, 11-18. https://doi.org/10.1016/j.amjmed.2004.07.051
[17]
Lorente, L., Lecuona, M., Jiménez, A., Mora, M.L. and Sierra, A. (2007) Influence of an Endotracheal Tube with Polyurethane Cuff and Subglottic Secretion Drainage on Pneumonia. American Journal of Respiratory and Critical Care Medicine, 176, 1079-1083. https://doi.org/10.1164/rccm.200705-761OC
[18]
Poelaert, J., Depuydt, P., De Wolf, A., Van de Velde, S., Herck, I. and Blot, S. (2008) Polyurethane Cuffed Endotracheal Tubes to Prevent Early Postoperative Pneumonia after Cardiac Surgery: A Pilot Study. The Journal of Thoracic and Cardiovascular Surgery, 135, 771-776. https://doi.org/10.1016/j.jtcvs.2007.08.052
[19]
Berra, L., De Marchi, L., Panigada, M., Yu, Z.-X., Baccarelli, A. and Kolobow, T. (2004) Evaluation of Continuous Aspiration of Subglottic Secretion in an in Vivo Study. Critical Care Medicine, 32, 2071-2078. https://doi.org/10.1097/01.CCM.0000142575.86468.9B
[20]
Damas, P., Frippiat, F., Ancion, A., Canivet, J.-L., Lambermont, B., Layios, N., Massion, P., Morimont, P., Nys, M. and Piret, S. (2015) Prevention of Ventilator-Associated Pneumonia and Ventilator-Associated Conditions: A Randomized Controlled Trial with Subglottic Secretion Suctioning. Critical Care Medicine, 43, 22-30. https://doi.org/10.1097/CCM.0000000000000674
[21]
Kharel, S., Bist, A. and Mishra, S.K. (2021) Ventilator-Associated Pneumonia among ICU Patients in WHO Southeast Asian Region: A Systematic Review. PLOS ONE, 16, e0247832. https://doi.org/10.1371/journal.pone.0247832
[22]
Muscedere, J., Sinuff, T., Heyland, D.K., Dodek, P.M., Keenan, S.P., Wood, G., Jiang, X., Day, A.G., Laporta, D. and Klompas, M. (2013) The Clinical Impact and Preventability of Ventilator-Associated Conditions in Critically Ill Patients Who Are Mechanically Ventilated. Chest, 144, 1453-1460. https://doi.org/10.1378/chest.13-0853
[23]
Jaensson, M., Olowsson, L.L. and Nilsson, U. (2010) Endotracheal Tube Size and Sore Throat Following Surgery: A Randomized-Controlled Study. Acta Anaesthesiologica Scandinavica, 54, 147-153. https://doi.org/10.1111/j.1399-6576.2009.02166.x
[24]
Karmali, S. and Rose, P. (2020) Tracheal Tube Size in Adults Undergoing Elective Surgery—A Narrative Review. Anaesthesia, 75, 1529-1539. https://doi.org/10.1111/anae.15041
[25]
Pacheco-Fowler, V., Gaonkar, T., Wyer, P. and Modak, S. (2004) Antiseptic Impregnated Endotracheal Tubes for the Prevention of Bacterial Colonization. Journal of Hospital Infection, 57, 170-174. https://doi.org/10.1016/j.jhin.2004.03.011
[26]
Pneumatikos, I.A., Dragoumanis, C.K., Bouros, D.E., Warner, D.S. and Warner, M.A. (2009) Ventilator-Associated Pneumonia or Endotracheal Tube-Associated Pneumonia? An Approach to the Pathogenesis and Preventive Strategies Emphasizing the Importance of Endotracheal Tube. The Journal of the American Society of Anesthesiologists, 110, 673-680. https://doi.org/10.1097/ALN.0b013e31819868e0
