LAUSR

www.ccmjournal.org Critical Care Medicine • Volume 46 • Number 1 (Supplement) Learning Objectives: The complications and costs associated with subglottic secretion pooling and subsequent aspiration in mechanically ventilated patients have been widely studied. Subglottic secretion drainage via specialty ETTs has been shown to reduce the incidence of VAP, ICU length of stay and antibiotic usage but their adoption is limited due to cost concerns and the challenge of selecting high-risk patients at the time of intubation. This is the very first clinical study evaluating a novel device that can be placed after intubation to remove secretions above the cuff. Methods: This is a prospective, observational study in a medical ICU at a large academic medical center. Adult, orally intubated patients expected to be on ventilator more than 72 hours were included. Typically within 0–24 hours of intubation, a Tri-Flo Subglottic Suction System was placed at the ETT cuff. The Tri-Flo Suction Catheter was secured to the ETT and suctioning was performed Q4 hours and PRN. Q4 oral care and continuous cuff pressure monitoring via the Cuff Sentry were used per hospital policy. Endpoints included ease of placement of the device, amount of secretions removed after placement and time to extubation. Results: Seventy-two (72) patients were included in the evaluation. The device was placed easily or very easily in 95.8% of patients (69/72). Though all patients were expected to be on the ventilator > 72 hours, 43% of patients were extubated in less than 72 hours. > 90% of patients had some secretions (small, moderate or large) removed through the Tri-Flo Subglottic Suction System and 55% had a moderate to large amount of secretions removed. 10% of patients had no secretions. None of the patients involved in the study were diagnosed with VAP. In the normal case, we would probably have seen at least one VAP in this high-risk population. In addition, from bronch BAL and non-bronch BAL specimens, amylase count has been significantly low suggesting no aspiration of gastric contents. Conclusions: The device was placed easily in all but 3 patients. The Tri-Flo Subglottic Suction System is an effective tool to clear secretions from above the endotracheal tube cuff. In a high-risk population, this device may be effective at reducing the risk of VAP.