Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-25T19:42:58.875Z Has data issue: false hasContentIssue false
  • English
  • Français

Is Continuous Subglottic Suctioning Cost-Effective for the Prevention of Ventilator-Associated Pneumonia?

Published online by Cambridge University Press:  02 January 2015

Corinne Hallais ,
Véronique Merle ,
Pierre-Gildas Guitard ,
Anne Moreau ,
Valérie Josset ,
Denis Thillard ,
Suzanne Haghighat ,
Benoit Veber  and
Pierre Czernichow
Corinne Hallais
Affiliation:
Department of Epidemiology and Public Health, Rouen University Hospital, Rouen, France
Véronique Merle*
Affiliation:
Department of Epidemiology and Public Health, Rouen University Hospital, Rouen, France
Pierre-Gildas Guitard
Affiliation:
Surgical Intensive Care Unit, Rouen University Hospital, Rouen, France
Anne Moreau
Affiliation:
Department of Epidemiology and Public Health, Rouen University Hospital, Rouen, France
Valérie Josset
Affiliation:
Department of Epidemiology and Public Health, Rouen University Hospital, Rouen, France
Denis Thillard
Affiliation:
Department of Epidemiology and Public Health, Rouen University Hospital, Rouen, France
Suzanne Haghighat
Affiliation:
Pharmacy Department, Rouen University Hospital, Rouen, France
Benoit Veber
Affiliation:
Surgical Intensive Care Unit, Rouen University Hospital, Rouen, France
Pierre Czernichow
Affiliation:
Department of Epidemiology and Public Health, Rouen University Hospital, Rouen, France
*
Department of Epidemiology and Public Health, Rouen University Hospital, 1 rue de Germont, 76031 Rouen Cedex, France ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To establish whether continuous subglottic suctioning (CSS) could be cost-effective.

Design.

Cost-benefit analysis, based on a hypothetical replacement of conventional ventilation (CV) with CSS.

Setting.

A surgical intensive care unit (SICU) of a tertiary care university hospital in France.

Patients.

All consecutive patients receiving ventilation in the SICU in 2006.

Methods.

Efficacy data for CSS were obtained from the literature and applied to the SICU of our hospital. Costs for CV and CSS were provided by the hospital pharmacy; costs for ventilator-associated pneumonia (VAP) were obtained from the literature. The cost per averted VAP episode was calculated, and a sensitivity analysis was performed on VAP incidence and on the number of tubes required for each patient.

Results.

At our SICU in 2006, 416 patients received mechanical ventilation for 3,487 ventilation-days, and 32 VAP episodes were observed (7.9 episodes per 100 ventilated patients; incidence density, 9.2 episodes per 10,000 ventilation-days). Based on the hypothesis of a 29% reduction in the risk of VAP with CSS than CV, 9 VAP episodes could have been averted. The additional cost of CSS for 2006 was estimated to be €10,585.34. The cost per averted VAP episode was €1,176.15. Assuming a VAP cost of €4,387, a total of 3 averted VAP episodes would neutralize the additional cost. For a low VAP incidence of 6.6%, the cost per averted VAP would be €1,323. If each patient required 2 tubes during ventilation, the cost would be €1,383.69 per averted VAP episode.

Conclusion.

Replacement of CV with CSS was cost-effective even when assuming the most pessimistic scenario of VAP incidence and costs.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 2 , February 2011 , pp. 131 - 135
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Chastre, J. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002;165:867–903.Google Scholar
2. Ibrahim, EH, Tracy, L, Chérie, H, Fraser, VJ, Kollef, MH. The occurrence of ventilator-associated pneumonia in a community hospital. Chest 2001;120:555–561.Google Scholar
3. Fagon, JY, Chastre, J, Hance, AJ, Montravers, P, Novara, A, Gibert, C. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med 1993;94:281–288.Google Scholar
4. Heyland, DK, Cook, DJ, Griffith, L, Keenan, SP, Brun-Buisson, C; Canadian Critical Trials Group. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. Am J Respir Crit Care Med 1999;159:1249–1256.Google Scholar
5. Drakulovic, MB, Torres, A, Bauer, TT, et al. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomized trial. Lancet 1999;354:1851–1858.CrossRefGoogle Scholar
6. Cook, D, Guyatt, G, Marshall, J, et al; Canadian Critical Care Trials Group. A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. NEngl J Med 1998;338:791–797.CrossRefGoogle ScholarPubMed
7. Kress, JP, Vinayak, AG, Levitt, J, Schweickert, WD, et al. Daily sedative interruption in mechanically ventilated patients at risk for coronary artery disease. Crit Care Med 2007;35:365–371.CrossRefGoogle ScholarPubMed
8. Babcock, HM, Zack, JE, Garrison, T, et al. An educational intervention to reduce ventilator-associated pneumonia in an integrated health system. Chest 2004;125:2224–2231.CrossRefGoogle Scholar
9. Omrane, R, Eid, J, Perreault, MM, et al. Impact of a protocol for prevention of ventilator-associated pneumonia. Ann Pharma-cother 2007;41:1390–1396.Google Scholar
10. Tablan, OC, Anderson, LJ, Besser, R, Bridges, C, Hajjeh, R. Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 2004; 53(RR-3):1–36.Google Scholar
11. Dezfulian, C, Shojania, K, Collard, HR, Kim, HM, Matthay, MA, Saint, S. Subglottic secretion drainage for preventing ventilator-associated pneumonia: a meta-analysis. Am J Med 2005;118:1450–1451.Google Scholar
12. Mahul, P, Auboyer, C, Jospe, R, et al. Prevention of nosocomial pneumonia in intubated patients: respective role of mechanical subglottic secretions drainage and stress ulcer prophylaxis. Intensive Care Med 1992;18:20–25.Google Scholar
13. Vallès, J, Artigas, A, Relio, J, et al. Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia. Ann Intern Med 1995;122:179–186.CrossRefGoogle ScholarPubMed
14. Kollef, MH, Skubas, NJ, Sundt, TM. A randomized clinical trial of continuous aspiration of subglottic secretions in cardiac surgery patients. Chest 1999;116:1339–1346.CrossRefGoogle ScholarPubMed
15. Bo, H, He, L, Qu, J. Influence of the subglottic secretion drainage on the morbidity of ventilator associated pneumonia in mechanically ventilated patients. Zhonghua Jie He He Hu Xi Za Zhi 2000;23:472–474.Google Scholar
16. Smulders, K, van der Hoeven, H, Weers-Pothoff, I, Vanden-broucke-Grauls, C. A randomized clinical trial of intermittent subglottic secretion drainage in patients receiving mechanical ventilation. Chest 2002;121:679–681.Google Scholar
17. Merle, V, Halláis, C, Tavolacci, MP, et al. Validity of medical staff assessment at admission of patient's risk of nosocomial infection: a prospective study in a surgical intensive care unit. Intensive Care Med 2006;32:915–918.Google Scholar
18. Shorr, AF, O'Malley, PG. Continuous subglottic suctioning for the prevention of ventilator-associated pneumonia: potential economic implications. Chest 2001;119:228–235.CrossRefGoogle ScholarPubMed
19. Youngquist, P, Carroll, M, Farber, M, et, al. Implementing a ventilator bundle in a community hospital, it Comm J Qual Patient Saf 2007;33:219–225.Google Scholar
20. Resar, R, Pronovost, P, Haraden, C, Simmonds, T, Rainey, T, Nolan, T. Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia. Jt Comm J Qual Patient Saf 2005;31:243–248.Google Scholar
21. RAISIN. Surveillance des infections nosocomiales en réanimation, France, résultats 2004. REA-RAISIN and Institut de Veille Sanitaire, September 2005. http://www.invs.sante.fr/publications/2005/rea_raisin_2004/rea_raisin_2004.pdf. Accessed March 8, 2010.Google Scholar
22. Kappstein, I, Schulgen, G, Beyer, U, Geiger, K, Schumacher, M, Daschner, FD. Prolongation of hospital stay and extra costs due to ventilator-associated pneumonia in an intensive care unit. Eur J Clin Microbiol Infect Dis 1992;11:504–508.Google Scholar
23. Papazian, L, Bregeon, F, Thirion, X. Effect of ventilator-associated pneumonia on mortality and morbidity. Am J Respir Crit Care Med 1996;154:91–97.CrossRefGoogle ScholarPubMed
24. Safdar, N, Dezfulian, C, Collard, HR, Saint, S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med 2005;33:2184–2190.CrossRefGoogle ScholarPubMed
25. Cocanour, CS, Ostrosky-Zeichner, L, Peninger, M, et al. Cost of a ventilator-associated pneumonia in a shock trauma intensive care unit. Surg Infect (Larchmt) 2005;6:65–72.Google Scholar
26. Harvey, RC, Miller, P, Lee, JA, Bowton, DL, MacGregor, DA. Potential mucosal injury related to continuous aspiration of subglottic secretion device. Anesthesiology 2007;107:666–669.CrossRefGoogle ScholarPubMed