Subglottic suctioning

Nearly every study done on the subject shows that the leading cause of ventilator associated pneumonia to be caused by secretions pooling above the endotracheal tube cuff, resulting in gradual, micro-aspiration.

According to studies done as far back as 2002 and reported on by the Centers for Disease Control and Prevention (CDC) suggest that subglottic suctioning may help reduce the risk for micro-aspiration.

A CDC report notes:

The endotracheal tube prevents glottic closure. As a result, the patient is unable to cough and remove secretions in a natural way. However, accumulation or pooling of oropharyngeal secretions above the endotracheal tube cuff occurs and then these fluids can be aspirated. See figure. 

Removal of these secretions by suction can reduce the risk of aspiration and may be the most cost effective and safe intervention. Four studies have shown subglottic suction to be safe and effective,14,38-40while only one study showed no difference in colonization. Figure 2 shows one method of performing subglottic suction with a separate suction catheter placed into the sub-glottic area.

Various ETTs are now available that allow for subglottic suctioning. Studies suggest that ETT that allow for subglottic suctioning help reduce the risk for VAP.
Whether an institution has them depends on budget, and on how the powers that be perceive the results of the various studies.

References:

1. Van Hooser, Theron, "Ventilator Associated Pneumonia: Best Practice Strategies for Caregivers," 2002, http://en.haiwatch.com/data/upload/tools/VAP_CEU_Booklet_Z0406.pdf, Kimberly Clark Co., accessed 4/21/14
2. "Intubation And VAP: A Complex Condition Requires Bundled Solution," rtmagazine.com, http://www.rtmagazine.com/2014/04/intubation-vap-complex-condition-bundled-solutions/, accessed 4/23/14

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