Diaz Emili, Rodríguez Alejandro H, Rello Jordi
Critical Care Department, University Rovira and Virgili. Institut Pere Virgili, Joan XXIII University Hospital, Carrer Dr Mallafre Guasch 4, 43007 Tarragona, Spain.
Respir Care. 2005 Jul;50(7):900-6; discussion 906-9.
Pooling of contaminated secretions above the cuff of the endotracheal tube predisposes patients to ventilator-associated pneumonia (VAP). Subglottic secretion drainage requires a special endotracheal tube that has a separate lumen that opens in the subglottic region above the tracheal tube. A recent meta-analysis of the 5 randomized clinical trials that evaluated the efficacy of removing these secretions found that this technique significantly reduces the incidence of VAP. One cost-effectiveness analysis showed savings of dollar 4,900 per episode of VAP prevented. Greatest benefit is derived by patients requiring fewer than 10 days of mechanical ventilation and not exposed to antibiotic therapy. Maintaining the intracuff pressure between 25 and 30 cm H2O is mandatory to guarantee effective drainage and safety. While silver-coated endotracheal tubes reduce pseudomonas pneumonia in intubated dogs and delay airway colonization in intubated patients, evaluation of studies with a variety of case mixes is warranted to identify subsets likely to benefit from the technique before it is implemented on a large scale. A patient who has a colonized airway and who undergoes percutaneous tracheotomy has an increased risk of VAP, particularly due to Pseudomonas aeruginosa, in the week following the procedure. As many studies suggest that incidence of VAP is highly dependent on the strategies of airway management, health care workers should be alerted to issues related to the artificial airway.
气管内插管套囊上方受污染分泌物的积聚使患者易患呼吸机相关性肺炎（VAP）。声门下分泌物引流需要一种特殊的气管内插管，该插管有一个单独的腔，在气管导管上方的声门区域开口。最近对5项评估清除这些分泌物疗效的随机临床试验进行的荟萃分析发现，该技术可显著降低VAP的发生率。一项成本效益分析表明，每预防一次VAP可节省4900美元。需要机械通气少于10天且未接受抗生素治疗的患者获益最大。必须将套囊内压力维持在25至30 cm H2O之间，以确保有效引流和安全。虽然镀银气管内插管可减少插管犬的铜绿假单胞菌肺炎，并延缓插管患者的气道定植，但在大规模实施该技术之前，有必要对各种病例组合的研究进行评估，以确定可能从该技术中获益的亚组。气道定植且接受经皮气管切开术的患者在术后一周发生VAP的风险增加，尤其是由铜绿假单胞菌引起的VAP。由于许多研究表明VAP的发生率高度依赖于气道管理策略，医护人员应警惕与人工气道相关的问题。
