Role of subglottic suctioning in the prevention of ventilator associated pneumonia in critically ill patients requiring invasive mechanical ventilation in a tertiary care hospital in South India.

This study is to assessthe role of subglottic suctioning in patients requiring mechanical ventilationin the Medical ICU.  As a part ofstandard care in intubated patients, the secretions from the respiratory tract areperiodically suctioned through the endotracheal tube using sterile suctioncatheters. However it was shown in multiple observational studies that thesubglottic space between the vocal cords and the bulb of the ET tube harbors apool of secretions that are not accessible for routine suctioning. This pool ofsecretions forms a focus for colonization of various bacteria which are shownto be responsible for Ventilator Associated Pneumonia (VAP). VAP prolongs theduration of ICU stay as well the mortality of the patient.  Also the financial burden due to a VAP is notonly the cost of additional ICU stay but also the second line antibiotics whichare often used in its treatment.

The central idea of thisstudy is an intervention enabling the clearance of the subglottic pool ofsecretions and its ability in prevention of VAP. Patients will be randomized toget either routine endotracheal suctioning alone or subglottic suctioning inaddition to the routine endotracheal suctioning. Subglottic suctioning is donethrough a port which opens into the subglottic region in specially designed ETtubes. Multiple randomized control trials world over have shown benefit withsubglottic suctioning in the prevention of VAP, however data from a developingcountries is lacking. We aim to show improved rates of VAP per ventilator days.