Would “Suction above Cuff” be a Better Option than the “Standard” Endotracheal Tube for the Prevention of Ventilator-Associated Pneumonia: A Randomized Study in Postoperative Neurological Patients

CONTEXT: Ventilator associated pneumonia is one the most common nosocomial infection encountered in the ICU patients. Despite of the implementation of the VAP prevention bundle, the incidence remains high. This can be attributed to the peritubal leak and the aspiration of the oropharyngeal secretions. The secretions further forms a nidus for the growth of organisms in the lower respiratory tract. In this study, a specialised tube, named ‘suction above cuff endotracheal tube’ is used, which has an additional suction port opening above the cuff. This is to facilitate timely aspiration of the secretion which pent-up above the cuff and gradually trickles down the trachea resulting in pneumonia. AIM: to compare the incidence of VAP with standard endotracheal tube (SETT) and suction above cuff endotracheal tube (SACETT) in neurological post-operative patients and its impact on clinical outcome. SETTINGS AND DESIGN: 60 patients of post-operative neurological cases aged ≥ 18 years and requiring intubation and/or ventilation and anticipated to remain on ETT for ≥48 h were randomized to receive either SETT or SACETT. RESULTS: In this study involving neurological population, there was no significant difference in incidence of clinical and microbiological VAP between SETT and SACETT group, when other strategies for VAP prevention were similar. Other outcomes were similar with use of either tube for intubation.