The risk of microaspiration during oral care in mechanically ventilated patients: A randomised cross-over study comparing two different suction protocols

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OBJECTIVES: To assess whether optimised oral care including subglottic suction could reduce microaspiration in comparison with a routine oral care. RESEARCH METHODOLOGY/DESIGN: An open prospective study comparing optimized»versus a routine oral care procedure in two randomised crossover consecutive periods of one day each. Optimised oral care consisted of suction via the subglottic suction port before and after a 10 seconds chlorhexidine oral care, compared with no use of the port during routine care. SETTING: Single-centre inclusion of critically ill patients ventilated for ≥48 hours with a subglottic suction endotracheal tube, no curare, Ramsay score not <3, and semi-quantitative assessments of tracheal secretions ≥ ++. MAIN OUTCOME MEASURES: Amylase being a relevant surrogate for oropharyngeal content, microaspirations were defined by tracheal/oral amylase ratio. RESULTS: 21 patients (11 and 10 with routine and optimised care in the first day respectively) with no baseline difference in risk of microaspiration. Neither difference in tracheal amylase amount or in tracheal/oral amylase ratio (1.5% (0.7%-16%) and 2.3% (0.6%-6%), p = 0.37) was observed indicating that microaspirations were not significantly decreased after optimized versus routine oral care. CONCLUSION: Suctioning by the subglottic port of endotracheal tubes may not decrease the risk of microaspiration during oral care of ventilated patients.

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