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Respir Care. 2019 Aug;64(8):986-993. doi: 10.4187/respcare.07107.

Airway Management and Ventilator-Associated Events.

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Department of Kinesiology, Respiratory Care Program, University of North Carolina at Charlotte, Charlotte, North Carolina.
Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, Illinois.


Airway management techniques are aimed at reducing complications associated with artificial airways and mechanical ventilation, such as retained secretions. The impact of airway management techniques on ventilator-associated events (VAEs) varies considerably by modality. Closed-suction techniques are generally recommended but have limited, if any, impact on VAEs. Normal saline instillation during suctioning is not recommended. Devices designed specifically to remove biofilm from the inside of endotracheal tubes appear to be safe, but their role in VAE prevention is uncertain. Subglottic secretion clearance by artificial cough maneuvers is promising, but more research is needed to assess its clinical feasibility. Continuous cuff-pressure management appears to be effective in reducing microaspiration of subglottic secretions.


airway management; biofilm; cuff pressure; mechanical ventilation; subglottic drainage; suctioning; ventilator-associated event; ventilator-associated pneumonia


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