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Intensive Care Med. 2004 Feb;30(2):225-233. doi: 10.1007/s00134-003-2077-4. Epub 2003 Nov 29.

Airway colonisation in long-term mechanically ventilated patients. Effect of semi-recumbent position and continuous subglottic suctioning.

Author information

1
Infection Control Unit, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris , 51 avenue Mal de Lattre de Tassigny, 94010, Créteil, France. emmanuelle.girou@hmn.ap-hop-paris.fr.
2
Department of Microbiology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 20-40 rue Leblanc, 75015, Paris, France.
3
Department of Anesthesiology, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, 51 avenue Mal de Lattre de Tassigny, 94010, Créteil, France.
4
Medical Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 20-40 rue Leblanc, 75015, Paris, France.
5
Department of Internal Medicine, Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, 1 place du Parvis Notre Dame, 75004, Paris, France.

Abstract

OBJECTIVE:

To evaluate the impact of continuous subglottic suctioning and semi-recumbent body position on bacterial colonisation of the lower respiratory tract.

DESIGN:

A randomised controlled trial.

SETTING:

The ten-bed medical ICU of a French university hospital.

PATIENTS:

Critically ill patients expected to require mechanical ventilation for more than 5 days.

INTERVENTIONS:

Patients were randomly assigned to receive either continuous suctioning of subglottic secretions and semi-recumbent body position or to receive standard care and supine position.

MEASUREMENTS AND RESULTS:

Oropharyngeal and tracheal secretions were sampled daily and quantitatively cultured. All included patients were followed up from day 1 (intubation) to day 10, extubation or death. Ninety-seven samples of oropharynx and trachea were analysed (40 for the suctioning group and 57 for the control group). The median bacterial counts in trachea were 6.6 Log10 CFU/ml (interquartile range, IQR, 4.4-8.3) in patients who received continuous suctioning and 5.1 Log10 CFU/ml (IQR 3.6-5.5) in control patients. Most of the patients were colonised in the trachea after 1 day of mechanical ventilation (75% in the suctioning group, 80% in the control group). No significant difference was found in the daily bacterial counts in the oropharynx and in the trachea between the two groups of patients.

CONCLUSION:

Tracheal colonisation in long-term mechanically ventilated ICU patients was not modified by the use of continuous subglottic suctioning and semi-recumbent body position.

PMID:
14647884
DOI:
10.1007/s00134-003-2077-4
[Indexed for MEDLINE]

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