Secretions in mechanically ventilated patients and duration of intubation

Introduction: Mechanically ventilated patients are at high risk for nosocomial pneumonia. The mortality can exceed 50% in these patients. Identification of high risk patients would permit prophylaxis or early treatment. Increasing secretions may be a predictor of patients who may progress to pneumonia. In this investigation we test a method for quantrtating secretions in mechanically ventilated patients. Methods: Ninety-six patients in the Medical Intensive Care Unit were studied for the first two weeks of their intubation. Secretions were collected daily for 4 hours with a suctioning protocol (1). Volume was quantitated and inflammatory cett counts were determined. Results: There was a twofold increase (p<0.03) in secretion volume over the 2nd week of intubation. Inflammatory eels were unchanged. Week 1 Week 2 B Vohjme(ml/4 hr) 2.3 5.0 <0.03 TCC × 10⁶/gram25.17±4.88 10.23±4.29 NS Neutrophite × 10 gram 16.5 6±3.22 6.792.83 NS Macrophages × 10 gram 8.03±1.56 3.2611.37 NS Lymphocytes ×10 gram 0.17±0.34 .07±0.03 NS TCC = total ceK count per gram of aspirate ×10⁶ Conclusions: Secretions can be measured and significantly increase with time in intubated critically ill patients. Longitudinal studies will determine if secretion volume is predictive of ventilator associated pneumonia.