1. Using Subglottic Endotracheal Tubes in Preventing Ventilator Assisted Pneumonia By: Nicole Durrance, Adriana Gomez, Esther Gonzalez, Marzette Solis BACKGROUND PURPOSE FRAMEWORK Ventilator Associated Pneumonia (VAP) is a major healthcare associated complication. Recent studies report 1-4 cases per 1,000 ventilator days (Coffin, Klompas, Classen, Arias, Podgorny, Anderson, & Yokoe, 2008). Despite the current bundle interventions there continues to be an increased rate of VAP. VAP contributes to higher mortality and morbidity rates as well as increases the length of hospital stay (Blot, Rello, & Vogelaers, 2011). It is because of these two critical outcomes that VAP is in high need of increased research. Test the effectiveness of the use of subglottic ETTs in decreasing the incidence of VAP in ICU patients. Florence Nightingale’s Environmental Theory REFERENCES HYPOTHESIS INDEPENDENT VARIABLE IMPLICATIONS PROBLEM Critically ill patients who are ventilated in an acute care unit commonly contract ventilator associated pneumonia (VAP). Thus, increasing mortality and morbidity rates. ICU patients on ventilators with subglottic ETTs will have a significantly reduced incidence of VAP compared to ICU patients who has the standard ETTs. ETT’s are predicted to be a more effective tool for nurses by decreasing length in time of procedure. This will also provide an increased benefit for the ICU patients by preventing VAP and help the hospital financially in the long run versus the use of standard ETT’s. IMPLEMENTATION PROCESS Data will be collected by utilizing a checklist measuring the amount and characteristics of secretions, the characteristics of lung sounds, and the amount of fluid accumulating in the lungs. Use of subglottic endotracheal tubes versus the use of standard endotracheal tubes. DEPENDENT VARIABLE Occurrence of VAP (chest x-ray, tracheal secretion samples), duration of ventilation, length of hospital stay Bouza, E., Perez, M. J., Munoz, P., Rincon, C., Barrio, J.M., Hortal, J. (2008). Continuous aspiration of subglottic secretions in the prevention of ventilator-associated pneumonia in the postoperative period of major heart surgery. Chest Journal, 134 (5), 938-946. doi:10.1378/chest.08-0103 Dezfulian, C., Shojania, K., Collard, H., Kim, M., Matthay, M., & Saint, S. (2005). Subglottic secretion drainage for preventing ventilator-associated pneumonia: a meta- analysis. The American Journal of Medicine, 118, 11-18. doi:10.1016/j.amjmed.2004.07.051 Krein, S., Lowalski, C., Damschroder, L., Forman, J., Kaufman, S., & Saint, S. (2008). Preventing ventilator- associated pneumonia in the United States: A multicenter mixed- methods study. Infection Control and Hospital Epidemiology, 29(10), 933- 940.doi:10.1086/591455 Smulders, K., Hoeven, H., Weers-Pothoff, I., & Vandenbroucke- Grauls, C. (2002). A randomized clinical trial of intermittent subglottic secretion drainage in patients receiving mechanical ventilation. CHEST Journal Offical Publication of the American College of Chest Physicians, 121(3), 856-862. doi: 10.1378/chest.121.3.858 A longitudinal comparison design with a convenience sampling technique will be used. A check list measuring the amount and characteristics of secretions, the characteristics of lung sounds, and the amount of fluid accumulating in the lungs will be used for data collection. METHOD