A study conducted by Ledgerwood et al. (2013) on the effects of tracheotomy tubes that have suction above the cuff established that the tubes have the capability to reduce VAP incidents. The amount of time spent in ICU and on the ventilator was also reduced. This does demonstrate that the patient was accorded the best treatment available to drain pleural effusion. The development of haemothorax/pneumothorax is anticipated in most patients who are intubated, but the risk is normally reduced. According to the different studies conducted, the likelihood of a patient suffering from VAP is decreased slightly when using SSD. The patient would still have contracted VAP if they were not intubated with the endotracheal tube. Therefore, the patient ended up incurring higher medical costs as they had to pay for the tube, and haemothorax/pneumothorax treatment. If they had not been intubated the patient would have only paid for the sickness. This additional cost is easily overlooked before the patient suffers from VAP, but once they are affected, the consequences are the same for all patients.
The tracheotomy tube should be suctioned after every one hour. During this procedure, the healthcare provider uses a syringe to suck the discharge from the tube. Healthcare providers have to decontaminate their hands before and after the procedure (Lacherade et al., 2010a). Failure to decontaminate their hands could result in passing of infections to the patient. This risk is increased since the patient has no way of knowing the hygiene of the care provider. The patient relies on the care provider to sanitize their hands before carrying out the suctioning procedure. Germs can easily be transmitted from the care provider to the patient if they do not sanitize their hands. This is because the tube is directly inserted in the patient's throat. The use of gloves when suctioning the discharge is highly recommended, this would ensure that both patient and nurse are protected at all times during the procedure.
The study by Smulders et al. (2002) was not able to identify any difference between control patients and those fitted with tracheotomy tubes. This lack of difference indicates that there is need for further research and development to determine the true efficacy of the tube. This would ensure that the little difference identified by the various studies is eliminated or justified. In regards to the patient, it is still not certain why they still suffered VAP. If the tube was effective in reducing the chances of the disease, then the patient was unlucky. The studies have all spoken about the benefits gained by using the tube, but none wants to accept that conducting a controlled study does not indicate the reality. The tyranny of numbers is that a small percentage cannot be used to indicate the truth for the population. There is still a possibility that the studies were biased since they allowed the nurses and the physicians to know of the study and the different patients. There is a possibility that the nurses took extra care over the intubated patients in the study than those within the hospital.
Pleural effusions could be removed using medications, but this is dependent on the type effusion. For the patient, the effusion required the intubation of an endotracheal tube size 8. This was the recommended size for an adult male as determined by the physician. According to Muscedere et al. (2011), the patient was not given the tube to prevent VAP, but rather in order to allow for the discharge of the pleural effusions. The failure to discharge properly the effusions would have resulted in a severe development of the disease. The discharge would have been deposited in their lower respiratory tract. Thus, the tracheotomy tube delayed the patient's development of VAP, which allowed them to recover progressively. The lack of the tube would have led to an early-onset of VAP.
The prevention of VAP is possible using SSD. The different studies and meta-analyses provided in the paper have determined that VAP can be prevented using SSD, but that is not a guarantee since some of the common cause of VAP are able to colonize the trachea. They adhere themselves to the endotracheal tube and this results in their passage to the respiratory tract. Prevention of VAP is better than curing the disease, and preventing the occurrence of VAP is beneficial to the patient, as they will not incur additional costs in treating pneumonia. The increased costs associated with purchase of the tube are mitigated over the long-term although there is no formal economic analysis done. All the research studies have concurred that the amount of time a patient spends in ICU is reduced, and they spend 3 days less on the mechanical ventilator. The reduction in number of days directly affects their economic savings as the ICU is expensive than a general ward. Speed of recovery is improved as they spend less time breathing using a machine and more time breathing on themselves. This does strengthen their lungs and increase their speed of recovery. Even with SSD, there is still a possibility of a patient contracting VAP. The percentage of this probability is reduced drastically when using SSD as seen in the different studies.
In the future, SSD needs further research to determine its full efficacy and methods of improvement. Currently, there are newer tubes purported to function better and eliminate the need for the nurse to suction. The tubes are able to discharge the suction, and this eliminates the need to keep checking on the tube. More research should be conducted to uncover more information on how to fully eliminate VAP in ICU patients.
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