Evaluation Background: Subglottic Aspiration Devices

February 8, 2023 | Evaluations & Guidance


Here's background for our Evaluations of subglottic aspiration devices, outlining the key considerations for making wise purchasing decisions. Learn how the technology is used, which specs are important, and what factors we test for. Also review our latest product ratings.

Subglottic aspiration devices are used to help prevent ventilator-associated pneumonia (VAP) by removing subglottic secretions that pool above the inflated cuff of an endotracheal or tracheostomy tube during mechanical ventilation. They are used with special endotracheal and tracheostomy tubes that incorporate subglottic secretion drainage (SSD) lumens. A subglottic aspiration device connects to the SSD port of the endotracheal or tracheostomy tube and provides regulated suction to remove the secretions.

Subglottic aspiration devices can be classified into:

  1. Continuous aspiration of subglottic secretions (CASS) devices—specialized suction regulators that connect to the facility's piped vacuum system to allow regulation of continuous vacuum at typically -20 mm Hg.

  2. Intermittent aspiration of subglottic secretions (IASS) devices—electric aspiration pumps that intermittently generate suction at, typically, -100 to -150 mm Hg. These devices do not need access to piped vacuum systems to function.

While IASS devices are new products, CASS devices have been in use for several decades.

However, despite the fact that VAP prevention guidelines recommend performing SSD, it has yet to become widely adopted. And of those facilities that do perform SSD, many do not use CASS or IASS devices but instead use syringes to periodically remove secretions—in spite of the fact that syringes generate suction levels that can damage the trachea—because this approach is far less costly.

While endotracheal tubes with SSD are more expensive than standard endotracheal tubes,...

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