Prospective Evaluation of Elective Tube Exchange in Patients Requiring Prolonged Mechanical Ventilation (PREVENT): Pilot Study.
CCCF ePoster library. Assiri A. Nov 2, 2016; 150982
Amer Assiri
Amer Assiri
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Topic: Clinical Trial

Prospective Evaluation of Elective Tube Exchange in Patients Requiring Prolonged Mechanical Ventilation (PREVENT): Pilot Study.

Assiri Amer1; McKechnie Kyle2; Muscedere John3
1Intensive Care Unit, Aseer Central Hospital, Abha, Saudi Arabia; 2Critical Care, Northern Ontario School of Medicine, Sudbury, ON, Canada; 3Critical Care Medicine Dep., Queen's university, Kingston, ON, Canada



Endotracheal tubes (ETT) with subglottic suctioning drainage (SSD) in mechanically ventilated patients have been demonstrated to reduce Ventilator Associated Pneumonia and may improve clinical outcomes. The best management strategy is unknown for patients admitted with standard ETTs who require ongoing mechanical ventilation. One strategy may be to electively replace the ETT but the benefits of reduced VAP risk must be balanced by the risk of tube exchange.  A randomized controlled trial (RCT) would be required to evaluate the risks and benefits. In preparation, we conducted a pilot study whose primary objective was to determine the safety and feasibility of ETT exchange in patients presenting with a standard ETT to one with SSD.

We included adult patients (> 18 years) with standard ETTs intubated <36 hours with expected ongoing tracheal intubation for >72 hours.  After consent, ETT exchange was done by an ICU attending/fellow using an exchange catheter. Sedation and paralysis were as per the procedural physician. Data were collected pre, during, and post procedure. Follow up was till ICU discharge or death
We enrolled 20 patients, Characteristics were [mean (SD)]:  age 64.5 years (11.4), APACHE II 29.1 (8.4), 17 were medical. At tube exchange, FiO2 was 0.37 (0.10), PEEP was 8.4 cm H2O (2.9). ICU length of stay was 19.1 days (17.25). ICU mortality was 30%, no deaths were related to ETT exchange. Only 1 complication, in 1 patient, was observed; a transient drop in oxygen saturation during the procedure. The study was stopped early due to lack of recruitment when institutional adoption of ETTs with SSD became the norm.
In this pilot study, elective ETT change was safe and feasible. A RCT on larger scale may be feasible in centers who have not adopted ETTs with SSD although further study may not be necessary if their adoption becomes the norm.


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