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Research ArticleOriginal Research

A Low-Sodium Solution for Airway Care: Results of a Multicenter Trial

Robert D Christensen, Erick Henry, Vickie L Baer, Nhan Hoang, Gregory L Snow, Gorgi Rigby, Jill Burnett, Susan E Wiedmeier, Roger G Faix and Larry D Eggert
Respiratory Care December 2010, 55 (12) 1680-1685;
Robert D Christensen
Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah.
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  • For correspondence: [email protected]
Erick Henry
Intermountain Healthcare
Institute for Healthcare Delivery Research, Salt Lake City, Utah.
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Vickie L Baer
Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah.
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Nhan Hoang
Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah.
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Gregory L Snow
Statistical Data Center, LDS Hospital, Salt Lake City, Utah.
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Gorgi Rigby
Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah.
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Jill Burnett
Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah.
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Susan E Wiedmeier
Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah.
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Roger G Faix
Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah.
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Larry D Eggert
Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah.
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Abstract

BACKGROUND: Normal saline is sometimes instilled into the endotracheal tube preparatory to airway suctioning, to assist in removing thick secretions. However, saline can damage the antimicrobial properties of airway secretions. We previously described a low-sodium physiologically based solution for airway care and reported a small (n = 60) randomized trial in neonates, which showed trends toward less ventilator-associated pneumonia (VAP) and less chronic lung disease with the new solution. We now report a multicenter trial of that solution.

METHODS: We conducted a before-and-after study with a parallel control group, in 4 level-3 neonatal intensive care units (NICUs). During year 1, all 4 NICUs used saline for airway care. During year 2, one NICU used the test solution exclusively while the other NICUs used saline exclusively. The 2 study outcomes were VAP (cases/1,000 ventilator days) and chronic lung disease, defined 3 ways: supplemental oxygen at 28 days; supplemental oxygen at 36 weeks gestation; and supplemental oxygen on hospital discharge.

RESULTS: During the study period 1,116 neonates had endotracheal intubation for respiratory management. Of those, 1,029 received the standard saline for airway suctioning, and the 87 in NICU 4 received the test solution. NICU 4 had a decrease in VAP rate, from 4.2 VAPs/1,000 ventilator days with saline, to 1.6 VAPs/1,000 ventilator days with the test solution (P = .04), and also had the lowest prevalence of chronic lung disease (P < .001 for each definition).

CONCLUSIONS: The test solution significantly reduced the VAP and chronic lung disease rates.

  • nosocomial infection
  • saline
  • airway care
  • endotracheal tube
  • ventilator-associated pneumonia
  • sepsis
  • chronic lung disease

Footnotes

  • Correspondence: Robert D Christensen MD, Neonatal Intensive Care, McKay-Dee Hospital Center, Intermountain Healthcare, 4403 Harrison Boulevard, Ogden UT 84403. E-mail: rdchris4{at}ihc.com.
  • This research was partly supported by a grant from the Deseret Foundation, Salt Lake City, Utah.

  • The authors have disclosed no conflicts of interest.

  • Copyright © 2010 by Daedalus Enterprises Inc.
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Respiratory Care: 55 (12)
Respiratory Care
Vol. 55, Issue 12
1 Dec 2010
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A Low-Sodium Solution for Airway Care: Results of a Multicenter Trial
Robert D Christensen, Erick Henry, Vickie L Baer, Nhan Hoang, Gregory L Snow, Gorgi Rigby, Jill Burnett, Susan E Wiedmeier, Roger G Faix, Larry D Eggert
Respiratory Care Dec 2010, 55 (12) 1680-1685;

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A Low-Sodium Solution for Airway Care: Results of a Multicenter Trial
Robert D Christensen, Erick Henry, Vickie L Baer, Nhan Hoang, Gregory L Snow, Gorgi Rigby, Jill Burnett, Susan E Wiedmeier, Roger G Faix, Larry D Eggert
Respiratory Care Dec 2010, 55 (12) 1680-1685;
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Keywords

  • nosocomial infection
  • saline
  • airway care
  • endotracheal tube
  • ventilator-associated pneumonia
  • sepsis
  • chronic lung disease

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