Background: In most ICUs, endotracheal suctioning is a common practice in mechanically ventilated patients to relieve the tracheobronchial tree from secretions. However, there are conflicting ideas in the clinical practice whether to instil normal saline or not prior to suctioning as one predisposed to develop more pneumonia in intubated and ventilated patients. This study aimed to determine the effect of normal saline instillation on the incidence of VAP.
Method: This is a randomized-controlled trial, including all adult patients requiring mechanical ventilation for more than 72 hours. Subjects were randomized into Group A, who received NSS pre-suctioning and Group B, who did not receieved NSS instillation pre-suctioning. Baseline characteristics were obtained and patients were followed up based on the clinical indications of VAP.
Results: A total of 150 patients were included in the study, 85 of which are males and 65 were females. Of the 150 patients, 75 received NSS pre-suctioning and 75 did not. There were no significant statistical differences on baseline characteristics except for higher incidence of diabetes mellitus in the NSS group (p-value of 0.000). Logistic regression analysis was done for diabetes mellitus and showed no significant difference between the two groups.
There were 95 patients who developed ventilator-associated pneumonia (VAP): 45 in those who received NSS and 50 in those who did no receive NSS instillation. However, there were no statistical difference between the two groups, (p-value of 0.498). The mean days to VAP were 3.80±3.62 days 2.88±2.44 days for NSS group and without NSS group respectively (p-value of 0.71)
Conclusion: Mechanically ventilated patients are prone to develop ventilator-associated pneumonia. In our study, neither NSS instillation nor without NSS instillation have an effect on the development of VAP. However, mucus plugging tends to be higher in patients with NSS. Therefore, utilization of NSS will not decrease nor increase the development of VAP but may be of help to ease the removal of secretions.