Effect of Perioperative Subglottic Secretion Drainage on Ventilator-Associated Pneumonia After Cardiac Surgery: A Retrospective, Before-and-After Study

J Cardiothorac Vasc Anesth. 2020 Oct 2:S1053-0770(20)31044-2. doi: 10.1053/j.jvca.2020.09.126. Online ahead of print.

ABSTRACT

OBJECTIVES: Although postoperative subglottic secretion drainage prevents ventilator-associated pneumonia (VAP) after cardiac surgery, its role during the perioperative period is unclear. For the present study, the effect of subglottic secretion drainage during and after cardiac surgery on postoperative VAP was investigated.

DESIGN: Retrospective, single-center, before-and-after study.

SETTING: Perioperative care of cardiac surgical patients in a tertiary university hospital.

PARTICIPANTS: Adult patients who underwent cardiac surgery from January 2013-December 2018.

INTERVENTIONS: Conventional and subglottic suctioning endotracheal tubes were used in the control and intervention groups before and after a change in institutional policy, respectively. In the intervention group, subglottic secretion drainage was performed continuously during surgery and intermittently after surgery.

MEASUREMENTS AND MAIN RESULTS: The risk of postoperative VAP, identified by the National Healthcare Safety Network surveillance definition algorithm, was compared by weighted logistic regression. Logistic regression analyses, with propensity score matching and inverse probability weighting, also were performed. A total of 2,576 patients were analyzed (control [n = 2108]; intervention [n = 468]). Postoperative VAP occurred less frequently in the intervention group (1/468 [0.2%]) compared with the control group (30/2,108 [1.4%]). In the multivariate weighted logistic regression analysis, the risk of VAP after cardiac surgery was significantly lower in the intervention group than in the control group (odds ratio 0.29; 95% confidence interval 0.14-0.58). Similar results were obtained in multivariate analyses after propensity score matching (odds ratio 0.04; 95% confidence interval 0.01-0.14) and inverse probability weighting (odds ratio 0.16; 95% confidence interval 0.05-0.42).

CONCLUSIONS: Routine perioperative subglottic secretion drainage using subglottic suctioning endotracheal tubes in patients undergoing cardiac surgery was associated with a reduction in the risk of VAP after surgery.

PMID:33127285 | DOI:10.1053/j.jvca.2020.09.126