The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

clinical Evaluation of the Boehringer CASS regulator on patients already receiving ContinuoUs Aspiration of Subglottic Secretions (CASS)

John J. Hill, RRT, Caroline Panichello, CRT, Charlotte Sims, CRT; Joseph Bestic CRT, David M. Murphy, MD, Michael J. Neary, MD; Deborah Heart and Lung Center, Browns Mills New Jersey.

Background: Continuous Aspiration of Subglottic Secretions (CASS) has been reported to be effective in reducing the incidence of Ventilator Associated Pneumonia (VAP). CASS is made possible with the use of special endotracheal tubes containing an additional lumen to allow for the removal of secretions above the cuff. For CASS to be safe and effective precision suction must be maintained in the -20mm Hg range. Given this low level of suction, the small lumen size, and the tenacious secretions encountered, the suction ports of these special ET tubes are prone to clogging over extended intubation times. ET tube instructions call for a syringe to be used to clear any blockage. A syringe delivers a momentary increase in suction to help remove any occlusion. The Boehringer CASS regulator has an integral pushbutton that allows the caregiver to momentarily apply a higher than normal level of suction. This option allows the occlusion to be cleared and replaces the need for a syringe. This allows the caregiver to clear the suction lines without exposure to patient fluids and without creating additional disposable medical waste.

Method: All thirty nine ICU beds of a critical care facility were converted to have Boehringer CASS regulators (Model 3720) available for intubated patients undergoing CASS. The incidence of VAP was tracked for a three month period. This rate was compared to the same months from two prior years where CASS had already been the standard of care.

Results: We found the number of cases of VAP to be reduced when using the Boehringer CASS regulator. In a retrospective study the cumulative VAP rate was 3.69, for the trial period the VAP rate was 2.85.

  VAP Cases / Vent Days  
  April May June 3mo. VAP Rate
2002 1 / 394 2 / 539 3 / 486 4.22
2003 0 / 329 2 / 368 1 /319 2.95
2004 1 / 358 0 / 331 2 / 363 2.85

Conclusion: The Boehringer CASS regulator reduced the occurrence of VAP in this study. The reduction of VAP rates experienced in this brief study period is compelling enough to merit further investigation into the benefits of this new device. A contemporary control group and longer study period will more clearly identify the clinical benefit. The new device allowed for a more consistent application of CASS, less exposure of caregivers to patient fluids, and less use of disposable medical products.