Intermittent Suction of Oral Secretions Before Each Positional Change may Reduce Ventilator-Associated Pneumonia: A Pilot Study

BACKGROUND: That ventilator-associated pneumonia (VAP) can be reduced by continuous and/or intermittent subglottic suction highlights the importance of clearance of oropharyngeal secretions. We prospectively evaluated the usefulness of intermittent suction of oral secretions before each positional change in reducing VAP. METHODS: A time-sequence nonrandomized intervention design was used. The study consisted of a 9-month observation phase (control group, 237 patients), a 6-month education phase, followed by a 7-month intervention phase (studied group, 227 patients). The occurrence of VAP, duration of mechanical ventilation, length of intensive care unit (ICU) stay, and mortality were recorded. RESULTS: VAP occurred less frequently in the studied group (6 of 227 patients, 2.6%) than in the control group (26 of 237 patients, 11.0%; P < 0.001). The incidence rate of VAP in control and studied groups was 6.51 and 2.04 per 1000 ventilator days, respectively (P = 0.002). For VAP patients, the ventilator days were 28.8 ± 17.2 days and 20.2 ± 4.0 days (P = 0.009), respectively, and the length of ICU stay was 27.6 ± 17.0 days and 20.3 ± 4.0 days (P = 0.012), respectively, in the control and studied groups. Intermittent suction of oral secretions before each positional change was the only independent factor responsible for a decrease of VAP in the studied group after stepwise logistic regression analysis (P = 0.003). CONCLUSIONS: Intermittent suction of oral secretions before each positional change may reduce VAP occurrence in ICU patients.