ICU's Patients Under Mechanical Ventilation Clinical Trial
Official title:
Impact of Drainage of Subglottic Secretions on Ventilator-Associated Pneumonia:a Randomised Multicentre Trial
The purpose of this study is to determine whether drainage of subglottic secretions is effective to reduce the incidence of pneumonia acquired under mechanical ventilation in ICU's patients.
Nosocomial infection represent a major problem in hospitals. In intensive care units,
ventilator-associated pneumonia (VAP) is associated with an increase in morbidity and
mortality. Incidence of VAP is high, 20 to 30% of patients under mechanical ventilation (MV)
for more than 48 hours. In the pathogenesis of VAP, two processes are considered essential
for its development: bacterial colonization of the oropharynx and tracheobronchial tract,
followed by aspiration of contaminated secretions into the lower airways. It has been shown
that pooled secretions above inflated endotracheal tube cuffs may be source of aspiration and
can be a cause of VAP. Several studies have suggested that recurrent aspiration of subglottic
secretions can be prevented by intermittent drainage of subglottic secretions. Nevertheless,
recent CDC guideline reported that there was not enough evidence to conclude on the efficacy
of such intervention.
During the study, patients, in both groups, will be intubated with the same device permitting
subglottic drainage (HiLo Evac endotracheal tube). The daily screening of VAP will be
performed until the 28th days of mechanical ventilation without occurrence of VAP. The
follow-up of each patient will be realized until the ICU’s discharge.
Comparison: The incidence of VAP will be compared between two groups: one group with
intermittent drainage of subglottic secretions and the other one without this intervention.
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