Impact of deep oropharyngeal suctioning on microaspiration, ventilator events, and clinical outcomes: A randomized clinical trial.

The primary outcome was null, so the main hypothesis was not supported. The subgroup effect was exploratory and was not the primary outcome. Both groups received standardized oral care delivered by study staff, which may itself have reduced secretions and obscured the added effect of deep suctioning. Most participants had subglottic suction endotracheal tubes, which may have influenced aspiration risk. Endotracheal cuff pressures were not controlled by the study protocol and could fluctuate between measurements. The study may not have had enough participants to detect some smaller effects because observed differences were smaller than predicted. Patients who stayed in the study long enough to be analysed were sicker than those who did not, so results may not apply to less severe patients. Ventilator-associated events have many causes, so oral suctioning may not affect them. Hospital length of stay depends on many factors, so the shorter stay cannot be attributed to suctioning.

The authors declared no conflicts of interest. The study received funding from the National Institutes of Health.

Do not read the shorter hospital stay or subgroup result as proof that deep suctioning alone works. The primary microaspiration outcome and VAE rate were null, the hospital stay and subgroup result were secondary or exploratory, and both groups received standard oral care.