Use of the blom tracheotomy tube with suction inner cannula to decontaminate microorganisms from the subglottic space A proof of concept

Lesley Rabach, Mark D. Siegel, Jonathan T. Puchalski, Dana Towle, Michelle Follert, Kelsey M. Johnson, Alfred W. Rademaker, Steven B. Leder*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Rationale: Preventing pulmonary complications during mechanical ventilation via tracheotomy is a high priority. Objectives: To investigate if the Blom tracheotomy tube with suctionabove-the-cuff inner cannula reduced the quantity of normal flora and pathogens in supra-versus subglottic spaces. Methods:We enrolled 20 consecutive medical ICU adults requiring tracheostomy for mechanical ventilation in this proof-of-concept, prospective, single-center study. All participants received a Blom tracheotomy tube with suction-above-the-cuff inner cannula to decontaminate microorganisms from the supra-and subglottic spaces. Supra-and subglottic sputum samples were obtained for microbiologic analysis while an endotracheal tube was in place before tracheotomy and once per week for up to 4 weeks of mechanical ventilation after tracheotomy. Measurements and Main Results: Demographics, duration of endotracheal tube intubation, and duration of mechanical ventilation post-tracheotomy were recorded. There was a significant reduction for supraglottic (2.86±1.11 [mean±SD]) versus subglottic suction samples (2.48±1.07) (paired t test, P = 0.048; Wilcoxon test, P = 0.045) when all data pairs for normal flora and pathogens were combined across times. There was a significant reduction of normal flora pooled across times in 19 data pairs for supraglottic (3.00±1.05) versus subglottic suction samples (2.00±0.94) (paired t test, P = 0.0004; Wilcoxon test, P = 0.0007). There was no significant reduction of pathogens pooled across times in 25 data pairs for supraglottic (2.76±1.16) versus subglottic suction samples (2.84±1.03) (paired t test, P = 0.75; Wilcoxon test, P = 0.83). Conclusions: Proof-of-concept was confirmed. The Blom tracheotomy tube with disposable suction-above-the-cuff inner cannula decontaminated microorganisms from the subglottic space when normal flora and pathogens were combined. Future research should investigate if decreased quantity of normal flora and pathogens in the subglottic space reduces the incidence of ventilator-associated pulmonary complications in critically ill patients requiring ongoing mechanical ventilation via tracheotomy.

Original languageEnglish (US)
Pages (from-to)859-863
Number of pages5
JournalAnnals of the American Thoracic Society
Volume12
Issue number6
DOIs
StatePublished - Jun 1 2015

Keywords

  • Intensive care unit
  • Mechanical ventilation
  • Tracheotomy
  • Ventilator-associated pneumonia

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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