Efficacy and Safety of Automated Antiseptic Lavage and Suctioning of Oral, Oropharyngeal, and Subglottic Secretions (Vapcare) AmongVentilated Patients with COVID-19 Developing VentilatorAssociated Events During Hospitalization: A Prospective RandomizedOpen Blinded End-Point Study
DOI:
https://doi.org/10.47363/JIDSCR/2022(3)167Keywords:
Globally, open-blinded, prospectiveAbstract
Background: Globally, invasive mechanical ventilation is one of the many methods relied on by intensivists to treat patients diagnosed with COVID-19. In this population, substandard oral care and secretion management permit the colonization of pathogens in the oral cavity and aspiration of these microbeladen secretions is the leading cause of ventilator-associated pneumonia (VAP). This study was conducted to analyze the effects of VapCare, an automated and intelligent secretion clearance and oral hygiene management system for VAP prevention, compared to the manual process.
Design: A single-center, prospective, randomized, open-blinded, end-point study was conducted on invasively ventilated patients diagnosed with COVID-19.
Setting: A tertiary care facility that is National Accreditation Board for Hospitals accredited in Bangalore, India.
Participants: Twelve adult patients diagnosed with COVID-19 via RT-PCR, antigen, computed tomography scan, or any other approved method intubated for at least 48 hours were recruited from the medical intensive care unit.
Intervention: Patients were given (n=6) or not given (n=6) the VapCare medical device along with the current standard of care.
Results: Six patients were assigned to the control group (Cx) that received manual suctioning, and six were assigned to the treatment group (Tx) that received VapCare. 3(50%) of the patients in the Cx experienced a ventilator-associated condition (VAC), and 2(33%) of the patients received a confirmed diagnosis of ventilator-associated pneumonia (VAP). There was no incidence of VAC or VAP in the Tx. With an outlier (subject two) excluded, the average cost of antibiotics per patient in the Tx was 32% less at 68,319 INR, while the average cost in the Cx was 100,783 INR. Clearance of secretions was almost 2x in the Tx compared to the Cx. The amount collected from the subglottic region (from where aspirations into the lungs can occur) was lower in the Tx (6.5 ml) when compared to the Cx (7.4 ml), showing that VapCare effectively clears secretions before they reach the subglottic region.
Conclusion: VapCare can reduce VAP incidence in invasively ventilated patients diagnosed with COVID-19. Antibiotic costs were also reduced by 32% in the Tx compared to the Cx. This study also allows us to hypothesize that automated suctioning can reduce the amount of secretions that can reach the subglottic region and, therefore, potentially reduce the chance of aspiration and, subsequently, VAP.
