A study to assess the correlation co-efficient between Microorganisms of Subglottic Secretions and Bronchoalveolar Lavage among Patients with Ventilator Associated Pneumonia in ICUs

Abstract

Introduction : Ventilator-associated pneumonia (VAP) is a well-known complication affecting up to 27% of mechanically ventilated patients. It accounts for approximately 25% of all ICU-acquired infections and for >50% of all antibiotic use in ICU patients. Hence the purpose of the current study was to assess the effectiveness of subglottic suctioning for prevention of VAP.Methods:  This was a Cross Sectional study design . The patients were randomly divided into two groups: Group A - No subglottic secretion drainage (NSSD) where they were intubated with ETT of without provision of suction above cuff and Group B- Continuous subglottic secretion drainage (CSSD). The coefficient of correlation for the microorganisms cultured from subglottic and BALF in each group was calculated using Pearson’s correlation.Results: The incidence of VAP among NSSD group was 41% and in CSSD group was 24% . The odds ratio was 0.457  with a relative risk reduction of 0.378. The most common microorganisms among the patients who were diagnosed with early onset VAP (EOVAP) was Klebsiella pneumoniae. In the total study population, the correlation coefficient was 0.76 . In the NSSD group, the correlation coefficient was 0.83 . In the CSSD group, correlation coefficient was 0.77 .The average number of days   of mechanical ventilation at the time of VAP diagnosis was more in CSSD group with 5.76 ± 0.71 days.Conclusion: The use of continuous subglottic suction reduces the incidence of VAP and the number of days of mechanical ventilation and duration of ICU stay. A greater concordance of organisms grown in subglottic and BALF cultures, when subglottic suction is not used, suggests a reduction of aspiration of subglottic secretions as a factor contributing to VAP when ETTs with subglottic suction are used.