TY - JOUR T1 - The association of subglottic secretion drainage and tracheal mucosa injury JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.RFMVC-2020.27 VL - 6 IS - suppl 4 SP - 27 AU - Li Yiating AU - Wang Yaochen Y1 - 2020/02/13 UR - http://openres.ersjournals.com/content/6/suppl_4/27.abstract N2 - Ventilator associated pneumonia (VAP) does not only increase patients’ mortality but also accrue the expenditure of medical resources. Prevention of VAP is thus an important issue in patients who are under ventilation support. Previous reports have recommended the use of subglottic secretion drainage (SSD) endotracheal tubes. Micro or macro aspiration secretion may be minimized by performing subglottic suctioning and therefore, decrease the incidence of VAP. However, several studies had discovered that tracheal mucosa injury could be induced by suction. We searched Cochrane Central, PubMed, and EMBASE up to March 2018, for randomized controlled trials (RCTs) that compared the efficacy of preventing VAP in different SSD, including continuous subglottic secretion drainage (CSSD) and intermittent subglottic secretion drainage (ISSD) and other articles about tracheal mucosa injury in SSD. Twenty-two RCTs (n = 3647) were reviewed. Low pressure CSSD were used in the most studies that failed to identify the benefit of VAP prevention. Fifteen studies (n=1694) were identified. CSSD were used in most of the studies focusing on suction induced tracheal mucosa injury. Moreover, the risk of CSSD in tracheal mucosal injury is higher than ISSD. However, in the patients with few oropharyngeal secretions, tracheal mucosa injury could still occur even when low pressure is applied. ISSD appears to cause less tracheal mucosa injury than CSSD when applying subglottic suction. ISSD could be optimized either by synchronizing suction frequency regarding to the rate of secretion accumulation or by irrigating the subglottic area with sterile fluids. However, maintaining optimal cuff pressure prior subglottic suction is mandatory.FootnotesCite this article as: ERJ Open Research 2020; 6: Suppl. 4, 27.This is an ERS Respiratory Failure and Mechanical Ventilation Conference abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only). ER -