Tracheal Secretion Management in the Mechanically Ventilated Patient: Comparison Between Standard Assessment and an Acoustic Secretion Detector

BACKGROUND: Standard indicators for endotracheal suctioning are often based on clinical judgment which relies on the deterioration of the patient's condition and/or routine suctioning. TBA Care(r), a secretion detector, analyses airway sounds and indicates the need for suctioning. In a prospective randomized trial we studied the efficacy of TBA Care(r) in detecting the presence of retained secretions compared to standard indicators. METHODS: 72 general ICU patients were randomized at intubation into two groups differing only from suctioning indications. Control group indications: at least three times a day or clinically driven. Secretion detector group indications: device signal or clinically driven. For each suctioning procedure we recorded the indication and amount of secretions removed. Patients were followed until ICU discharge or extubation. Diagnosis of ventilator-associated pneumonia (VAP) was confirmed by analysis of the tracheal aspirate. RESULTS: We recorded a total of 1705 suctioning procedures in the control group and 1354 in the secretion detector group. Patients in the secretion detector group were suctioned less frequently (3.9 ±2.3 vs. 4.8±1.2 suctioning procedures/day; p=0.002) and with a lower rate of "unnecessary" suctionings (3.5% vs. 12.1%; p<0.001). In the secretion detector group 97.3% suctioning procedures were performed following indication of the device while in the control group clinical deterioration (65.2%) was the most frequent indicator. The incidence of VAP was similar in both groups. CONCLUSIONS: TBA Care(r) seems a valid indicator for timely suctioning, anticipating clinical deterioration due to secretion retention and reducing unnecessary suctioning procedures.