• Hui-Hwa Tsai, Fang-Chi Lin, and Shi-Chuan Chang.
• Medical and Surgical Intensive Care Unit, Taipei Veterans General Hospital, Taipei, Taiwan.
• Am. J. Med. Sci. 2008 Nov 1;336(5):397-401.

BackgroundThat ventilator-associated pneumonia (VAP) can be reduced by continuous and/or intermittent subglottic suction highlights the importance of clearance of oropharyngeal secretions. We prospectively evaluated the usefulness of intermittent suction of oral secretions before each positional change in reducing VAP.MethodsA time-sequence nonrandomized intervention design was used. The study consisted of a 9-month observation phase (control group, 237 patients), a 6-month education phase, followed by a 7-month intervention phase (studied group, 227 patients). The occurrence of VAP, duration of mechanical ventilation, length of intensive care unit (ICU) stay, and mortality were recorded.ResultsVAP occurred less frequently in the studied group (6 of 227 patients, 2.6%) than in the control group (26 of 237 patients, 11.0%; P < 0.001). The incidence rate of VAP in control and studied groups was 6.51 and 2.04 per 1000 ventilator days, respectively (P = 0.002). For VAP patients, the ventilator days were 28.8 +/- 17.2 days and 20.2 +/- 4.0 days (P = 0.009), respectively, and the length of ICU stay was 27.6 +/- 17.0 days and 20.3 +/- 4.0 days (P = 0.012), respectively, in the control and studied groups. Intermittent suction of oral secretions before each positional change was the only independent factor responsible for a decrease of VAP in the studied group after stepwise logistic regression analysis (P = 0.003).ConclusionsIntermittent suction of oral secretions before each positional change may reduce VAP occurrence in ICU patients.

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