Abstract
Background:
Micro-aspiration of bacteria-laden secretions into the lower respiratory tract is a key aspect in the pathogenesis of VAE. SSD-ETTs have been developed with a small lumen above the cuff, connected to a suction line, allowing for removal of secretions accumulating over time. However, reported rates of SSD-ETT clogging have been as high as 48%. Tri-Flo subglottic suction system is a new subglottic suction device that includes a larger, 14Fr suction line. We evaluated comparative performance in 30 patients to determine the relative suction efficiency of a SSD-ETT to this novel device.
Methods:
This is a retrospective, chart review in the MICU at a large community regional medical center. IRB approval was obtained. Patients orally intubated were included. Upon admission to the ICU unit, a Tri-Flo subglottic suction line was placed in each patient. The majority of patients were intubated with a SSD-ETT. Intermittent suction 60-120, was alternately connected to the SSD-ETT and Tri-Flo approximately 4 h of every 12-h shift.
Results:
30 patients were included in the evaluation. Data was collected in 20 patients for both SSD-ETT and Tri-Flo. Comparative data was unable to be collected on the remaining 10 patients due to placement of a standard ETT (3 patients), inability to place the Tri-Flo subglottic suction system (3 patients) and inadequate time prior to extubation (4 patients). Information was collected over a total of 57 ventilator days for the 20 patients with comparative data. Tri-Flo removed more secretions than SSD-ETT in 16 patients, the same amount (± 10%) in 2 patients and the SSD-ETT removed more secretions in 2 patients. In total, across all 20 patients, Tri-Flo removed more than twice as many secretions as SSD-ETT (1,496 mL vs. 725 mL). SSD-ETT removed zero secretions in 6/20 (30% of patients) versus 1/20 (5% of patients) for Tri-Flo. 17 patients were on the ventilator for >48 h. Of these patients, 1 had a reported VAC. This is notably lower than our baseline rate with SSD-ETT alone.
Conclusions:
Tri-Flo is a new tool that enables effective removal of secretions above the cuff. In 80% of patients Tri-Flo removed more secretions than the SSD-ETT. SSD-ETT removed zero secretions in 30% of patients, indicating the device was clogged or otherwise non-functional, versus 5% for Tri-Flo. Tri-Flo subglottic suction system removes more secretions than SSD-ETT on average, providing increased protection against micro-aspiration.
Disclosures:
None.
SSD ETT vs. Tri-Flo Assessment
Insertion #
#of Days of Data
SSD-ETT
Tri-flo
1
2
0
18
3
2
35
100
4
1
0
13
5
1
10
15
6
10
203
461
7
10
63
373
8
5
88
33
11
4
163
150
12
1
3
25
15
1
2.3
31
16
2
8.5
24
18
3
19
14
19
1
7
23
21
1
12
42
22
1
28
56
23
6
83
103
24
1
0
5
26
1
0
0
27
1
0
5
29
1
0
5
Total
57
724.8
1496
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