Saline instillation before tracheal suctioning decreases the incidence of ventilator-associated pneumonia

Critical Care Medicine

Volumn 37, Issue 1, 2009, Pages 32-38

  Caruso, Pedro ^a   Denari, Silvia ^a   Ruiz, Soraia A L ^b   Demarzo, Sergio E ^a   Deheinzelin, Daniel ^b  

^a A C CAMARGO CANCER CENTER   (Brazil)

^b HOSPITAL SÍRIO LIBANÊS   (Brazil)

Author keywords

Pneumonia; Prevention; Respiratory therapy; Ventilator associated pneumonia

Indexed keywords

ANTIBIOTIC AGENT; ANTIINFECTIVE AGENT; CORTICOSTEROID; HISTAMINE H2 RECEPTOR ANTAGONIST; PROTON PUMP INHIBITOR; SODIUM CHLORIDE; ISOTONIC SOLUTION;

ADULT; AGED; ARTIFICIAL VENTILATION; ATELECTASIS; BACTERIUM CULTURE; CANCER CENTER; CLINICAL TRIAL; CONTROLLED CLINICAL TRIAL; CONTROLLED STUDY; FEMALE; HUMAN; INFECTION PREVENTION; INFECTION RATE; INFECTION RISK; INTENSIVE CARE UNIT; LAVAGE; LUNG LAVAGE; MAJOR CLINICAL STUDY; MALE; PRIORITY JOURNAL; RANDOMIZED CONTROLLED TRIAL; REVIEW; RISK REDUCTION; SINGLE BLIND PROCEDURE; STOMACH ULCER; SUCTION; THERAPY EFFECT; THORAX RADIOGRAPHY; TRACHEA; TRACHEA OBSTRUCTION; TREATMENT DURATION; VENTILATOR ASSOCIATED PNEUMONIA; ARTICLE; COMPARATIVE STUDY; DRUG INSTILLATION; ENDOTRACHEAL INTUBATION; INCIDENCE; MIDDLE AGED;

AGED; FEMALE; HUMANS; INCIDENCE; INSTILLATION, DRUG; INTUBATION, INTRATRACHEAL; ISOTONIC SOLUTIONS; MALE; MIDDLE AGED; PNEUMONIA, VENTILATOR-ASSOCIATED; PULMONARY ATELECTASIS; SODIUM CHLORIDE; SUCTION; TRACHEA;

EID: 59649103968     PISSN: 00903493     EISSN: 15300293     Source Type: Journal    
DOI: 10.1097/CCM.0b013e3181930026     Document Type: Article

References (46)

1. Cook DJ, Walter SD, Cook RJ, et al: Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 1998; 129:433-440
2. Safdar N, Dezfulian C, Collard HR, et al: Clinical and economic consequences of ventilator-associated pneumonia: A systematic review. Crit Care Med 2005; 33:2184-2193
3. Vincent JL, Bihari DJ, Suter PM, et al: The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 1995; 274:639-644
4. Valles J, Artigas A, Rello J, et al: Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia. Ann Intern Med 1995; 122:179-186
5. Branson RD: The ventilator circuit and ventilator-associated pneumonia. Respir Care 2005; 50:774-785; discussion 785-777
6. Kollef MH, Shapiro SD, Fraser VJ, et al: Mechanical ventilation with or without 7-day circuit changes. A randomized controlled trial. Ann Intern Med 1995; 123:168-174
7. Craven DE, Goularte TA, Make BJ: Contaminated condensate in mechanical ventilator circuits. A risk factor for nosocomial pneumonia? Am Rev Respir Dis 1984; 129:625-628
8. AARC clinical practice guideline. Endotracheal suctioning of mechanically ventilated adults and children with artificial airways. American Association for Respiratory Care. Respir Care 1993; 38:500-504
9. Sole ML, Byers JF, Ludy JE, et al: A multisite survey of suctioning techniques and airway management practices. Am J Crit Care 2003; 12:220-230; quiz 231-222
10. Raymond SJ: Normal saline instillation before suctioning: helpful or harmful? A review of the literature. Am J Crit Care 1995; 4:267-271
11. Hagler DA, Traver GA: Endotracheal saline and suction catheters: Sources of lower airway contamination. Am J Crit Care 1994; 3:444-447
12. 2 and amount of secretions. Heart Lung 1987; 16:532-537
13. Demers RR, Saklad M: Minimizing the harmful effects of mechanical aspiration. Heart Lung 1973; 2:542-545
14. Adair CG, Gorman SP, Feron BM, et al: Implications of endotracheal tube biofilm for ventilator-associated pneumonia. Intensive Care Med 1999; 25:1072-1076
15. Inglis TJ, Millar MR, Jones JG, et al: Tracheal tube biofilm as a source of bacterial colonization of the lung. J Clin Microbiol 1989; 27:2014-2018
16. Sottile FD, Marrie TJ, Prough DS, et al: Nosocomial pulmonary infection: Possible etiologic significance of bacterial adhesion to endotracheal tubes. Crit Care Med 1986; 14:265-270
17. Kollef MH, Prentice D, Shapiro SD, et al: Mechanical ventilation with or without daily changes of in-line suction catheters. Am J Respir Crit Care Med 1997; 156:466-472
18. Dreyfuss D, Djedaini K, Gros I, et al: Mechanical ventilation with heated humidifiers or heat and moisture exchangers: Effects on patient colonization and incidence of nosocomial pneumonia. Am J Respir Crit Care Med 1995; 151:986-992
19. Girault C, Breton L, Richard JC, et al: Mechanical effects of airway humidification devices in difficult to wean patients. Crit Care Med 2003; 31:1306-1311
20. Hess DR, Kallstrom TJ, Mottram CD, et al: Care of the ventilator circuit and its relation to ventilator-associated pneumonia. Respir Care 2003; 48:869-879
21. Fabregas N, Ewig S, Torres A, et al: Clinical diagnosis of ventilator associated pneumonia revisited: Comparative validation using immediate post-mortem lung biopsies. Thorax 1999; 54:867-873
22. Chastre J, Fagon JY, Bornet-Lecso M, et al: Evaluation of bronchoscopic techniques for the diagnosis of nosocomial pneumonia. Am J Respir Crit Care Med 1995; 152:231-240
23. Mayhall CG: Ventilator-associated pneumonia or not? Contemporary diagnosis. Emerg Infect Dis 2001; 7:200-204
24. Pound MW, Drew RH, Perfect JR: Recent advances in the epidemiology, prevention, diagnosis, and treatment of fungal pneumonia. Curr Opin Infect Dis 2002; 15:183-194
25. el-Ebiary M, Torres A, Fabregas N, et al: Significance of the isolation of Candida species from respiratory samples in critically ill, non-neutropenic patients. An immediate postmortem histologic study. Am J Respir Crit Care Med 1997; 156:583-590
26. Rello J, Esandi ME, Diaz E, et al: The role of Candida sp isolated from bronchoscopic samples in nonneutropenic patients. Chest 1998; 114:146-149
27. Bland JM, Altaian DG: Survival probabilities (the Kaplan-Meier method). BMJ 1998; 317: 1572
28. Bland JM, Altaian DG: The logrank test. BMJ 2004; 328:1073
29. Chmura Kraemer H, Periyakoil VS, Noda A: Kappa coefficients in medical research. Stat Med 2002; 21:2109-2129
30. de Latorre FJ, Pont T, Ferrer A, et al: Pattern of tracheal colonization during mechanical ventilation. Am J Respir Crit Care Med 1995; 152:1028-1033
31. George DL, Falk PS, Wunderink RG, et al: Epidemiology of ventilator-acquired pneumonia based on protected bronchoscopic sampling. Am J Respir Crit Care Med 1998; 158:1839-1847
32. Torres A, el-Ebiary M, Gonzalez J, et al: Gastric and pharyngeal flora in nosocomial pneumonia acquired during mechanical ventilation. Am Rev Respir Dis 1993; 148:352-357
33. Gray JE, MacIntyre NR, Kronenberger WG: The effects of bolus normal-saline instillation in conjunction with endotracheal suctioning. Respir Care 1990; 35:785-790
34. Jablonski RS: The experience of being mechanically ventilated. Qual Health Res 1994; 4:186-207
35. Maffessanti M, Berlot G, Bortolotto P: Chest roentgenology in the intensive care unit: an overview. Eur Radiol 1998; 8:69-78
36. O'Neal PV, Grap MJ, Thompson C, et al: Level of dyspnoea experienced in mechanically ventilated adults with and without saline instillation prior to endotracheal suctioning. Intensive Crit Care Nurs 2001; 17:356-363
37. Blackwood B: Normal saline instillation with endotracheal suctioning: Primum non noc-ere (first do no harm). J Adv Nurs 1999; 29:928-934
38. Shorten DR, Byrne PJ, Jones RL: Infant responses to saline instillations and endotracheal suctioning. J Obstet Gynecol Neonatal Nurs 1991; 20:464-469
39. Ackerman MH: The effect of saline lavage prior to suctioning. Am J Crit Care 1993; 2:326-330
40. Maschmeyer G, Bertschat FL, Moesta KT, et al: Outcome analysis of 189 consecutive cancer patients referred to the intensive care unit as emergencies during a 2-year period. Eur J Cancer 2003; 39:783-792
41. Soares M, Salluh JI, Spector N, et al: Characteristics and outcomes of cancer patients requiring mechanical ventilatory support for >24 hrs. Crit Care Med 2005; 33: 520-526
42. Kress JP, Christenson J, Pohlman AS, et al: Outcomes of critically ill cancer patients in a university hospital setting. Am J Respir Crit Care Med 1999; 160:1957-1961
43. Chastre J, Fagon JY: Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002; 165:867-903
44. Rello J, Ollendorf DA, Oster G, et al: Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 2002; 122:2115-2121
45. Park DR: The microbiology of ventilator-associated pneumonia. Respir Care 2005; 50: 742-763; discussion 763-745
46. Wunderink RG: Nosocomial pneumonia, including ventilator-associated pneumonia. Proc Am Thorac Soc 2005; 2:440-444