Pneumonia, Bacterial Clinical Trial
Official title:
Relation Between the Volume of Subglottic Secretion and Risk of Extubation Failure in ICU Patients
This study evaluates the relation between the volume of subglottic secretion before airway extubation and the risk of extubation failure in the ICU patient.
Between 10 and 20% of patients develop extubation failure (10.7% in our ICU at 2018), which
is related to an increased in-hospital death rate, infections, higher costs and longer
hospital stays. Tracheal secretions, LVEF<30%, MV > 7d, Weak of cough are identified as risk
factors of extubation failures but are not completely performants. Avoiding reintubation
remains an important clinical goal.
The subglottic secretion drainage above the cuff of an endotracheal tube is recognized as an
effective method to prevent ventilator‑associated pneumonia (VAP) in critically ill patients.
The subglottic secretion drainage is used in a regular way in our ICU. Volume of subglottic
secretion is not analysed in the scientific literature.
Study :
The investigators hypothesize that high volume of subglottic secretion before extubation is
associated with high risk of extubation failure and à high risk of pneumonia post extubation.
All planned extubations in the intensive care unit after 2 days minimal of mechanic
ventilation are recorded on a designated form and standard variables charted. All data will
be collected retrospectively after the extubation event.
All included patients will be assigned a unique identification number (UID) by the
investigator, who will secure the patient identifiers in an encrypted electronic file. The
cause of extubation failure will be recorded (as identified by the attending physician on
service, who is not involved in the study).
For statistical analysis, group that fail extubation, will be compared, with the group that
was an extubation success. Standard demographics (age, sex), patient disease related factors
(diagnosis, duration of intubation, secretions), care factors (cuff leak test, p/f ratio
prior to extubation,LVEF<30% ), and post extubation care (post extubation respiratory
support, stridor, blood gas, pneumonia) along with any complication during extubation and
reintubation and reasons for reintubation will be collected and compared.
As two groups are being compared, bivariate analyses utilizing Chi-square tests or univariate
logistic regression for categorical variables and Student t -tests for interval variables,
will be done.
Investigators will perform an interim analysis at the end of 12 months and a final analysis
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