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American Journal of Critical Care. 2003;12: 99-100
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LETTERS TO THE EDITORS

To the Editors:

I am the nurse manager of an 18-bed MSICU at Morton Plant Hospital in Clearwater, Florida. I loved your editorial "Dying by Irreconcilable Numbers." We work closely with a group of intensivists, and we are doing many of the things described in your article as "clear opportunities for safety improvement," such as early enteral nutrition and the use of ultrasound guidance for cardiovascular line insertions. One thing we are not familiar with is the "continuous aspiration of subglottic secretions to prevent VAP [ventilator-associated pneumonia]." Could you please provide a reference article for us to explore this?

I also believe it is part of our obligation to make nursing more attractive. My unit has a very low turnover rate and rarely has a vacancy. I am proud of my team members, who have worked together to make our unit an attractive workplace—I only wish others would take our example!

Kelly McLeay, RN, MSN
Clearwater, Fla

The Editors reply

Thank you for your kind remarks and interest in our editorial "Dying by Irreconcilable Numbers."1 The information you seek about the removal of subglottic secretions can be found in the publications of the Agency for Healthcare Research and Quality. The specific Internet address is http://www.ahrq.gov/clinic/ptsafety/chap17a.htm#17.2. This section provides an overview2 and 3 studies3–5 graded "1" on the scale for the quality of the evidence.

The Web site, as mentioned in the editorial, is a "must" for anyone interested in improving patient outcomes and safety.

The Editors

REFERENCES

  1. Bryan-Brown CW, Dracup K. Dying by irreconcilable numbers. Am J Crit Care. 2003;12:1–3.
  2. Craven DE, Steger KA. Nosocomial pneumonia in mechanically ventilated adult patients: epidemiology and prevention in 1996. Semin Respir Infect 1996;11:32–53.[Medline]
  3. Mahul P, Auboyer C, Jospe R, et al. Prevention of nosocomial pneumonia in intubated patients: respective role of mechanical subglottic secretions drainage and stress ulcer prophylaxis. Intensive Care Med. 1992;18:20–25.[Medline]
  4. Valles J, Artigas A, Rello J, et al. Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia. Ann Intern Med. 1995;122:179–186.[Abstract/Free Full Text]
  5. Kollef MH, Skubas NJ, Sundt TM. A randomized clinical trial of continuous aspiration of subglottic secretions in cardiac surgery patients. Chest. 1999; 116:1339–1346.[Abstract/Free Full Text]




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