2003 OPEN FORUM Abstracts
EVALUATION OF THE HI LO EVAC TUBE AS AN ADJUNCT THERAPY IN THE PREVENTION
OF VENTILATOR ASSOCIATED PNEUMONIA.
John J. Hill, RRT Co-Technical Director, Respiratory Care Department; Caroline Panichello, CRT, DJ. Schlosser, RRT; Charlotte Sims, GRT and the Respiratory Care Department; Linda Simontacchi, Infection Control RN; David M. Murphy, MD Medical Director/Chairman ; Marivi Ora, MD Pulmonary Attending; Michael J. Neary, MD Co-Medical Director/SICU Attending, Robert Bender, DO MICU Attending; Raymond Wargovich,MD MICU Attending, Deborah Heart and Lung Center, Browns Mills New Jersey, Deborah Heart and Lung Center, made the decision to evaluate the Hi Lo Evac tube (Mallinckrodt, St. Louis) as an adjunct in managing ventilator associated pneumonia (VAP).
The Hi Lo Evac tube is a special endotracheal tube with a port positioned above the cuff. This port can be attached to continuous suction or have intermittent suction applied via a syringe to remove secretions that accumulate above the cuff. Research has shown that the organisms present in these secretions are the same as those found causing pneumonia in ventilated patients. The premise is that these secretions are aspirated by the ventilated patient causing the pneumonia. The Hi Lo Evac tube allows these secretions to be removed from the subglottic space, decreasing the possibility of them being aspirated and causing the pneumonia.
Method: The study was three months in length, during this time, all patients at Deborah Heart and Lung Center were intubated with the Hi Lo Evac tube, patients transferred from other facilities already intubated, and those in the ICUs already intubated were exempted. All tubes were placed on continuous suction at 20 cm of suction, as recommended by the manufacturer. Postoperative patient tubes were placed on suction upon arrival in the ICU. All manipulation of the endotracheal tube during this time, other than suctioning through the tube, was done by the respiratory therapists.
Results: 236 patients were enrolled into the pilot study. 4 patients utilizing the Hi-Lo Evac tube developed VAP.
Conclusion: The VAP rate at Deborah Heart and Lung Center during the three month trial period was below the national rate. However, this may have been an effect of the higher level of awareness of VAP during the study. The decision was made to continue the data collection for a one year period, and reevaluate the results at that time.