Economic and Clinical Impact of Automated Suction device on VAP prevention in Mechanically Ventilated Neurocritical Care Patients. A Randomized Controlled Non-Inferiority trial

Ventilator associated pneumonia is a common and preventable hospital acquired infection among mechanically ventilated patients and leads to prolonged ICU stay increased antibiotic use and higher healthcare costs. Neurocritical care patients are at particularly high risk because they require longer ventilation and intensive monitoring resulting in a greater economic burden. Although standard ventilator associated pneumonia prevention bundles are effective adherence is variable and manual suctioning increases nursing workload. Automated airway management systems such as Automated Oropharyngeal and Subglottic Suction AOPS may improve secretion clearance reduce ventilator associated pneumonia incidence shorten ventilation duration lessen antibiotic requirements and lower ICU costs. However evidence on their economic impact in neurocritical care is limited.

This single centre open label prospective randomized non inferiority study will be conducted in the ICU at NIMHANS Bangalore. Adult neurointerventional and neurosurgical patients requiring mechanical ventilation will be randomized to automated suctioning or conventional manual suctioning. All patients will receive standard ventilator associated pneumonia prevention measures. The study will compare average per day direct ICU costs as the primary outcome. Secondary outcomes include costs of medications diagnostics consumables equipment human resource utilization duration of ventilation antibiotic use escalation patterns ICU stay investigation frequency and safety outcomes. Indirect patient costs such as loss of wages will also be assessed.