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Ann Am Thorac Soc. 2015 Jun;12(6):859-63. doi: 10.1513/AnnalsATS.201501-010BC.

Use of the Blom Tracheotomy Tube with Suction Inner Cannula to Decontaminate Microorganisms from the Subglottic Space. A Proof of Concept.

Author information

1
1 Department of Surgery, Section of Otolaryngology.
2
2 Department of Internal Medicine, Section of Pulmonary and Critical Care, and.
3
3 Department of Internal Medicine, Section of Pulmonary and Critical Care, Yale School of Medicine, New Haven, Connecticut.
4
4 Department of Laboratory Medicine.
5
5 Medical Intensive Care Unit, and.
6
6 Yale-New Haven Hospital, New Haven, Connecticut; and.
7
7 The Robert H. Lurie Comprehensive Cancer Center, Biostatistics Core Facility, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Abstract

RATIONALE:

Preventing pulmonary complications during mechanical ventilation via tracheotomy is a high priority.

OBJECTIVES:

To investigate if the Blom tracheotomy tube with suction-above-the-cuff inner cannula reduced the quantity of normal flora and pathogens in supra- versus subglottic spaces.

METHODS:

We enrolled 20 consecutive medical ICU adults requiring tracheostomy for mechanical ventilation in this proof-of-concept, prospective, single-center study. All participants received a Blom tracheotomy tube with suction-above-the-cuff inner cannula to decontaminate microorganisms from the supra- and subglottic spaces. Supra- and subglottic sputum samples were obtained for microbiologic analysis while an endotracheal tube was in place before tracheotomy and once per week for up to 4 weeks of mechanical ventilation after tracheotomy.

MEASUREMENTS AND MAIN RESULTS:

Demographics, duration of endotracheal tube intubation, and duration of mechanical ventilation post-tracheotomy were recorded. There was a significant reduction for supraglottic (2.86 ± 1.11 [mean ± SD]) versus subglottic suction samples (2.48 ± 1.07) (paired t test, P = 0.048; Wilcoxon test, P = 0.045) when all data pairs for normal flora and pathogens were combined across times. There was a significant reduction of normal flora pooled across times in 19 data pairs for supraglottic (3.00 ± 1.05) versus subglottic suction samples (2.00 ± 0.94) (paired t test, P = 0.0004; Wilcoxon test, P = 0.0007). There was no significant reduction of pathogens pooled across times in 25 data pairs for supraglottic (2.76 ± 1.16) versus subglottic suction samples (2.84 ± 1.03) (paired t test, P = 0.75; Wilcoxon test, P = 0.83).

CONCLUSIONS:

Proof-of-concept was confirmed. The Blom tracheotomy tube with disposable suction-above-the-cuff inner cannula decontaminated microorganisms from the subglottic space when normal flora and pathogens were combined. Future research should investigate if decreased quantity of normal flora and pathogens in the subglottic space reduces the incidence of ventilator-associated pulmonary complications in critically ill patients requiring ongoing mechanical ventilation via tracheotomy.

KEYWORDS:

intensive care unit; mechanical ventilation; tracheotomy; ventilator-associated pneumonia

PMID:
25849332
DOI:
10.1513/AnnalsATS.201501-010BC
[Indexed for MEDLINE]

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