Abstract
Chronic microaspiration through a tracheal cuff is the main culprit in the penetration and colonization of the lower respiratory tract. A total of 145 patients intubated for more than 3 days were randomly assigned to a double nosocomial pneumonia (NP) prevention: 1-Prevention of aspiration by hourly subglottic secretion drainage (SSD) with a specific endotracheal tube (HI-LO Evac tube, Mallinckrodt); 2-Prevention of gastric colonization using either sucralfate or antacids. Four random groups were defined, similar in age and severity of illness. Subglottic secretion drainage treatment was associated with: a) a twice lower incidence of NP (no-SSD: 29.1%, SSD: 13%); b) a prolonged time of onset of NP (no-SSD: 8.3±5 days, SSD: 16.2±11 days); c) a decrease in the colonization rate from admission to end-point day in tracheal aspirates (no-SSD:+21.3%, SSD:+6.6%) and in subglottic secretions (no-SSD:+33.4%, SSD:+2.1%). Sucralfate was not associated with a significantly lower incidence of NP (antacids: 23.6%, sucralfate: 17.8%), but with a lower increase in the colonization rate in subglottic and gastric aspirates, from admission to end-point day.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Schwartz SN, Dowling JN, Benkovic C, Dequittner-Buchanan M, Prostko T, Yee RB (1978) Sources of gram negative bacilli colonizing the tracheae of intubated patients. J Infect Dis 138:227–231
Cross AS, Roup B (1981) Role of respiratory devices in endemic nosocomial pneumonia. Am J Med 70:681–685
Atherton ST, White DJ (1978) Stomach as a source of bacteria colonizing respiratory tract during artificial ventilation. Lancet II:968–969
Van Uffelen R, Van Saene HKF, Fidler V, Lowenberg A (1984) Oropharyngeal flora as a source of bacteria colonizing the lower airways in patients on artificial ventilation. Intensive Care Med 10:233–237
du Moulin GC, Paterson DG, Hedley-White J, Lisbon A (1982) Aspiration of gastric bacteria in antacid-treated patients: a frequent cause of postoperative colonisation of the airway. Lancet I:242–245
Spray SB, Zuidema GD, Cameron JL (1976) Aspiration pneumonia: incidence of aspiration with endotracheal tubes. Am J Surg 131:701–703
Elpern EH, Jacobs ER, Bone RC (1987) Incidence of aspiration in tracheally intubated adults. Heart Lung 16:527–531
Tryba M (1987) Risk of acute stress bleeding and nosocomial pneumonia in ventilated intensive care units: sucralfate versus antacids. Am J Med [Suppl]: 83:117–124
Driks MR, Craven DE, Celli BR, Manning M, Burke RA, Garvin GM, Kunches LM, Farber HW, Wedel SA, Mccabe WR (1987) Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers. N Engl J Med 317:1376–1382
Le Gall JR, Loirat P, Alperovitch A, Glaser P, Granthil C, Mathieu D, Mercer P, Thomas R, Villers D (1984) A simplified acute physiology score for ICU patients. Crit Care Med 12:975–977
Johanson WG, Pierce AK, Sanford JP, Thomas GD (1972) Nosocomial respiratory infections with gram negative bacilli. Ann Int Med 77:701–706
Salata RA, Ellner JJ (1988) Bacterial colonization of the tracheobronchial tree. Chest Med 9:623–633
Huxley EJ, Viroslav J, Gray WR, Pierce AK (1978) Pharyngeal aspiration in normal adults and patients with depressed consciousness. Am J Med 64:564–568
Cameron JL, Reynolds J, Zuidema GD (1973) Aspiration in patients with tracheostomies. Surg Gynecol Obstet 136:68–70
Bernhardt WN, Cottrell JE, Swakumara G (1979) Adjustement of intracuff pressure to prevent aspiration. Anesthesiology 50:B 63
Milewski P, Ernst G (1983) Eine einfache Methode zur Absaugung und Spülung des subglottischen Raumes der Jammerrecke beim tracheotomierten Langzeitbeatmungspatienten. Anaesthesist 33: 126–127
Craven DE, Kunches LM, Kilinsky V, Lichtenberg DA, Make BJ, Mccabe WR (1986) Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation. Am Rev Respir Dis 133:792–796
Fagon JY, Chastre J, Domart Y, Trouillet JL, Pierre J, Darne C, Gibert C (1989) Nosocomial pneumonia in patients receiving continuous mechanical ventilation: prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques. Am Rev Respir Dis 139:877–884
Salata RA, Lederman NM, Shlaes DM, Jacobs MR, Eckstein E, Tweardy D, Toossi Z, Chmielewski R, Marino J, King CH, Graham RC, Ellner JJ (1987) Diagnosis of nosocomial pneumonia in intubated intensive care units patients. Am Rev Respir Dis 135:427–432
Langer M, Mosconi P, Mandelli M (1989) Long term respiratory support and risk of pneumonia in critically ill patients. Am Rev Respir Dis 140:302–305
Jiminez P, Torres A, Rodriguez-Roisin R, Bellacasa JP, Aznar R, Gatell JM, Agusti-Vidal A (1989) Incidence and etiology of pneumonia acquired during mechanical ventilation. Crit Care Med 17:882–885
Niederman MS, Mntovani R, Schoch P, Papas J, Fein AM (1989) Patterns and routes of tracheobronchial colonization in mechically ventilated patients; the role of nutritional status in colonization of the lower airway by pseudomonas species. Chest 95:155–161
Niederman MS, Rafferty TD, Sasaki CT, Merill WW, Matthay RA, Reynolds NY (1983) Comparison of bacterial adherence to aliated and squamous epithelial cells obtained from the human respiratory tract. Am Rev Respir Dis 127:85–90
Johanson WG Jr, Pierce AK, Sanford JP (1969) Changing pharyngeal flora of hospitalized patients: emergence of gram-negative bacilli. N Engl J Med 281:1137–1140
Cannon LA, Heiselman D, Gardner W, Jones J (1987) Prophylaxis of upper gastro-intestinal tract bleeding in mechanically ventilated patients: a randomized study comparing the efficacy of sucralfate, cimetidine and antacids. Arch Intern Med 147:2101–2106
Laggner AN, Lenz K, Base W, Drume W, Schneeweiss B, Grimm G (1989) Prevention of upper gastrointestinal bleeding in long term ventilated patients: sucralfate versus ranitidine.Am J Med 86 [Suppl 6A]:81–84
Ryan P, Dawson J, Teres D, Navab F (1990) Continuous infusion of cimetidine versus sucralfate: incidence of pneumonia and bleeding compared. Crit Care Med 18:253
Cooks DJ, Laine LA, Guyatt GH, Raffin TA (1991) Nosocomial pneumonia and the role of gastric ph; a meta-analysis. Chest 100:7–13
Tryba M, Mantey-Stiers F (1987) Antibacterial activity of sucralfate in human gastric juice. Am J Med [Suppl 3 B] 83:125–127
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Mahul, P., Auboyer, C., Jospe, R. et al. Prevention of nosocomial pneumonia in intubated patients: Respective role of mechanical subglottic secretions drainage and stress ulcer prophylaxis. Intensive Care Med 18, 20–25 (1992). https://doi.org/10.1007/BF01706421
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01706421