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Subglottic suction frequency and adverse ventilator-associated events during critical illness

Published online by Cambridge University Press:  11 January 2021

Hatem O. Abdallah ,
Melanie F. Weingart ,
Risa Fuller ,
David Pegues ,
Rebecca Fitzpatrick  and
Brendan J. Kelly Open the ORCID record for Brendan J. Kelly [Opens in a new window]
Hatem O. Abdallah
Affiliation:
Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Melanie F. Weingart
Affiliation:
Department of Medicine, University of Colorado, Aurora, Colorado
Risa Fuller
Affiliation:
Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
David Pegues
Affiliation:
Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Rebecca Fitzpatrick
Affiliation:
Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Brendan J. Kelly*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
*
Author for correspondence: Brendan J. Kelly, E-mail: brendank@pennmedicine.upenn.edu
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Abstract

Objective:

Tracheal intubation and mechanical ventilation provide essential support for patients with respiratory failure, but the course of mechanical ventilation may be complicated by adverse ventilator-associated events (VAEs), which may or may not be associated with infection. We sought to understand how the frequency of subglottic suction, an indicator of the quantity of sputum produced by ventilated patients, relates to the onset of all VAEs and infection-associated VAEs.

Design:

We performed a case-crossover study including 87 patients with VAEs, and we evaluated 848 days in the pre-VAE period at risk for a VAE.

Setting and participants:

Critically ill patients were recruited from the medical intensive care unit of an academic medical center.

Methods:

We used the number of as-needed subglottic suctioning events performed per calendar day to quantify sputum production, and we compared the immediate pre-VAE period to the preceding period. We used CDC surveillance definitions for VAE and to categorize whether events were infection associated or not.

Results:

Sputum quantity measured by subglottic suction frequency is greater in the period immediately prior to VAE than in the preceding period. However, it does not discriminate well between infection-associated VAEs and VAEs without associated infection.

Conclusions:

Subglottic suction frequency may serve as a valuable marker of sputum quantity, and it is associated with risk of a VAE. However, our results require validation in a broader population of mechanically ventilated patients and intensive care settings.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 7 , July 2021 , pp. 826 - 832
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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