Prevention of nosocomial pneumonia in intubated patients: respective role of mechanical subglottic secretions drainage and stress ulcer prophylaxis.

ABSTRACT

Chronic microaspiration through a tracheal cuff is the main culprit in the penetration and colonization of the lower respiratory tract. A total of 145 patients intubated for more than 3 days were randomly assigned to a double nosocomial pneumonia (NP) prevention 1--Prevention of aspiration by hourly subglottic secretion drainage (SSD) with a specific endotracheal tube (HI-LO Evac tube, Mallinckrodt); 2--Prevention of gastric colonization using either sucralfate or antacids. Four random groups were defined, similar in age and severity of illness. Subglottic secretion drainage treatment was associated with a) a twice lower incidence of NP (no-SSD 29.1%, SSD 13%); b) a prolonged time of onset of NP (no-SSD 8.3 +/- 5 days, SSD 16.2 +/- 11 days); c) a decrease in the colonization rate from admission to end-point day in tracheal aspirates (no-SSD +21.3%, SSD +6.6%) and in subglottic secretions (no-SSD +33.4%, SSD +2.1%). Sucralfate was not associated with a significantly lower incidence of NP (antacids 23.6%, sucralfate 17.8%), but with a lower increase in the colonization rate in subglottic and gastric aspirates, from admission to end-point day.