The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts


Kenneth Mill, Linda Cornman, Robert Leshko, Angela Lutz; LVHN, Allentown, PA

Introduction: Patients in the intensive care unit (ICU) are at risk for dying not only from their critical illness but also from secondary processes such as nosocomial infections. Pneumonia is the second most common nosocomial infection in critically ill patients, affecting 27% of all critically ill patients. Eighty-six percent of nosocomial pneumonias are associated with mechanical ventilation and are termed ventilator-associated pneumonia (VAP). A primary goal of any clinical institution is to reduce its current VAP rate. One postulated etiologies of ventilator-associated pneumonia is the development of bacteria Biofilm. A growing body of evidence has demonstrated that bacterial colonization of the gastrointestinal tract, with subsequent aspiration around the endotracheal tube cuff, is a major source of VAP. A preventive strategy gaining momentum is the use of new endotracheal tubes designed to reduce the risk of VAP. Endotracheal tubes which have a separate suction lumen that allows for continuous suctioning of subglottic secretions. This action prevents aspirated bacteria from around the cuff to travel into the lower respiratory tract. Hi-Lo Evac and Seal Guard are sub-glottic endotracheal tubes that may help reduce the development of a Biofilm and aspiration. Body: To help reduce the current VAP rate at Lehigh Valley Health Network, the following processes were implemented: First, a multi-disciplinary team was formed to examine and assess our institution’s current management of patients on mechanical ventilated patients. The committee reviewed current CDC recommendations and scientific journals’ outcome data. Based on the above findings, the utilization of the Hi-Lo EVAC and Seal Guard (Mallinckrodt, Tyco, Pleasanton, CA) endotracheal tube were instituted. Formal and bedside clinical education was conducted along with the development of on-line computer tracking of types of endotracheal tube insertion. Results: Since implementation of the sub-glottic endotracheal tubes four years ago, our institutional VAP rate has been reduced from an apex of seventy-nine to its current level of eighteen. Conclusion: Since the advent of the utilization of sub-glottic endotracheal tube, there has been a significant reduction in our institution’s VAP rate. A multi-disciplinary approach to reduce our VAP rate to even a lower value will continue to be a major hospital initiative. Sponsored Research - None VAPs Rate