2004 OPEN FORUM Abstracts
THE EFFECT OF Continuous ASPIRATION OF SUBGLOTTIC SECRETIONS (CASS) ON VENTILATOR ASSOCIATED PNEUMONIA (VAP), TWO YEAR STUDY.
John
J. Hill, RRT, Caroline Panichello, CRT, DJ. Schlosser, RRT,
Charlotte Sims, CRT, Patricia Touanen, RN, Roberta Benz, RN, Gloria
Sonnesso, RN MSN, David M. Murphy, MD, Marivi Ora, MD, Michael J.
Neary, MD; Deborah Heart and Lung Center, Browns Mills, New Jersey.
Background:
Continuous aspiration of subglottic secretions in ventilator
patients has been recommended by the Agency for Healthcare Research
and Quality (AHRQ) and the Centers for Disease Control as a clinical
practice effective in reducing the incidence of healthcare related
pneumonia. During a twenty four month study at Deborah Heart and
Lung Center, CASS was made the standard of care for all intubated
patients. The incidence of VAP during this period was compared to
results prior to incorporating CASS. Organisms present in subglottic
secretions are the potential precursor to the onset of VAP.
Preventing these organisms from pooling and multiplying is the
primary aim of a CASS regimen. CASS is performed using a special ET
tube that features a dorsal lumen to remove secretions from above the
endotracheal tube cuff (Hi-Lo Evac, Mallinckrodt, Inc.). Special
care was taken to minimize damage to surrounding tracheal tissue by
employing precise low-level (15-30mmHg) suction. (Boehringer
Laboratories, Inc. Pediatric suction regulator)
Method:
All patients at Deborah Heart and Lung Center were intubated with
these special ET tubes using standard technique. The suction lumens
of these tubes were connected to a precision suction source set to
-20mm Hg, with an appropriate collection system in place.
Results:
During the twenty four month period the VAP rate for the patients
with the Hi-Lo Evac tube was 3.6. Since our study was not conducted
on a calendar year, the data was compared to complete calendar years
in which the CASS was not the standard of care.
| VAP Rates | ||||
| W/O CASS | W/CASS | |||
| 1999 | 2000 | 2001 | Year 1 | Year 2 |
| 11.5 | 4.26 | 7.3 | 4.32 | 3.34 |
Conclusion:
The number of patients treated with this method and the positive
results obtained speak to the clinical utility of this procedure.
During the twenty four month period the incidence of VAP at Deborah
Heart and Lung Center continued to remain significantly below the
national median as reported by the National Nosocomial Infections
Surveillance System.