Kollef M H, Skubas N J, Sundt T M
Department of Internal Medicine, Pulmonary and Critical Care Division, Washington University School of Medicine, St. Louis, MO, USA.
Chest. 1999 Nov;116(5):1339-46. doi: 10.1378/chest.116.5.1339.
To determine whether the application of continuous aspiration of subglottic secretions (CASS) is associated with a decreased incidence of ventilator-associated pneumonia (VAP).
Prospective clinical trial.
Cardiothoracic ICU (CTICU) of Barnes-Jewish Hospital, St. Louis, a university-affiliated teaching hospital.
Three hundred forty-three patients undergoing cardiac surgery and requiring mechanical ventilation in the CTICU.
Patients were assigned to receive either CASS, using a specially designed endotracheal tube (Hi-Lo Evac; Mallinckrodt Inc; Athlone, Ireland), or routine postoperative medical care without CASS.
One hundred sixty patients were assigned to receive CASS, and 183 were assigned to receive routine postoperative medical care without CASS. The two groups were similar at the time of randomization with regard to demographic characteristics, surgical procedures performed, and severity of illness. Risk factors for the development of VAP were also similar during the study period for both treatment groups. VAP was seen in 8 patients (5.0%) receiving CASS and in 15 patients (8. 2%) receiving routine postoperative medical care without CASS (relative risk, 0.61%; 95% confidence interval, 0.27 to 1.40; p = 0. 238). Episodes of VAP occurred statistically later among patients receiving CASS ([mean +/- SD] 5.6 +/- 2.3 days) than among patients who did not receive CASS (2.9 +/- 1.2 days); (p = 0.006). No statistically significant differences for hospital mortality, overall duration of mechanical ventilation, lengths of stay in the hospital or CTICU, or acquired organ system derangements were found between the two treatment groups. No complications related to CASS were observed in the intervention group.
Our findings suggest that CASS can be safely administered to patients undergoing cardiac surgery. The occurrence of VAP can be significantly delayed among patients undergoing cardiac surgery using this simple-to-apply technique.
确定应用声门下分泌物持续吸引（CASS）是否与呼吸机相关性肺炎（VAP）发病率降低相关。
前瞻性临床试验。
圣路易斯巴恩斯-犹太医院心胸重症监护病房（CTICU），一家大学附属医院。
343例在CTICU接受心脏手术并需要机械通气的患者。
患者被分配接受CASS（使用专门设计的气管内导管（Hi-Lo Evac；Mallinckrodt公司；爱尔兰阿斯隆））或不进行CASS的常规术后医疗护理。
160例患者被分配接受CASS，183例被分配接受不进行CASS的常规术后医疗护理。两组在随机分组时，在人口统计学特征、所进行的外科手术以及疾病严重程度方面相似。两个治疗组在研究期间发生VAP的危险因素也相似。接受CASS的8例患者（5.0%）和接受不进行CASS的常规术后医疗护理的15例患者（8.2%）发生了VAP（相对风险，0.61%；95%置信区间，0.27至1.40；p = 0.238）。接受CASS的患者发生VAP的时间在统计学上晚于未接受CASS的患者（[平均值±标准差]5.6±2.3天）（2.9±1.2天）；（p = 0.006）。两个治疗组在医院死亡率、机械通气总时长、住院或CTICU住院时长或获得性器官系统紊乱方面未发现统计学上的显著差异。干预组未观察到与CASS相关的并发症。
我们的研究结果表明，CASS可安全应用于接受心脏手术的患者。使用这种易于应用的技术，接受心脏手术的患者发生VAP的时间可显著延迟。
