2003 OPEN FORUM Abstracts
CONTINUOUS ASPIRATION OF SUBGLOTTIC SECRETIONS- IMPACT ON VENTILATOR ASSOCIATED PNEUMONIA IN A GENERAL INTENSIVE CARE UNIT
Paul Garbarini, MS, RRT; Betsy Ryland, RRT; Sentara Healthcare, Virginia Beach, Va.
Purpose: The aim of this study was to assess the impact of Continuous Aspiration of Subglottic Secretions (CASS) on Ventilator Associated Pneumonia (VAP) rates in a community based general intensive care unit.
Background: Continuous 'micro' aspiration of subglottic secretions has been reported to be a primary casual factor in development of VAP. Respiratory Care, Infection Control, Nursing, Emergency Medicine and Anesthesia implemented hospital wide adoption of 'CASS' in an attempt to further reduce VAP. Other infection control practices related to mechanical ventilation remained unchanged during the study period. These included passive humidification up to 72hrs, heated wire humidification to minimize circuit breakage, closed suction system, head of bed elevated to >30 degrees, circuit changes q7d and medication administration by MDI per protocol.
Methodology: CASS ETT tubes (Mallinckrodt Hi-Lo® Evac ETT) replaced all adult ETT tubes outside the Operating Room. CASS tubes were placed in OR by Anesthesia on high risk cases or cases admitted to ICU postop. CASS was maintained continuously at 20mmHg. For safety, a distinctive looking Pediatric Suction regulator with a maximum pressure of 100mm Hg (Boehringer Laboratories) was utilized. Suction lumen was manually bolused q4hrs to assure patency. VAP rates were compared one-year retrospectively vs. post CASS implementation. VAP diagnosis was defined per CDC guidelines and utilized the CDC/NNIS (National Nosocomial Infections Surveillance System) data summary reports for Benchmarking.
| PRE-CASS | POST CASS | |
| # VAP's | 18 | 8 |
| VENT DAYS | 1083 | 993 |
| VAP RATE | 16.6 | 8.1 |
| % VAP RATE DECREASE | 52% | P = 0.04 |
Conclusions: Implementation of CASS resulted in a 52% decrease in VAP rates. This result is consistent with controlled studies reporting a 40-50% reduction in VAP rates. These results were achieved despite Apache II increased patient acuity over the study period.