The Science Journal of the American Association for Respiratory Care

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.

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