• Karam Nam, Jung-Bin Park, Wan Beom Park, Nam Joong Kim, Younghae Cho, Hwan Suk Jang, Ho Young Hwang, Sue Hyun Kim, Yeiwon Lee, Seohee Lee, Jinyoung Bae, Youn Joung Cho, Eun Jin Kim, Minjeong Kim, and Yunseok Jeon.
• Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
• J. Cardiothorac. Vasc. Anesth. 2021 Aug 1; 35 (8): 2377-2384.

ObjectivesAlthough 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.DesignRetrospective, single-center, before-and-after study.SettingPerioperative care of cardiac surgical patients in a tertiary university hospital.ParticipantsAdult patients who underwent cardiac surgery from January 2013-December 2018.InterventionsConventional 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 ResultsThe 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).ConclusionsRoutine 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.Copyright © 2020. Published by Elsevier Inc.

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