Control of tracheal cuff pressure may cut ventilator-associated pneumonia

Reuters Health Information (2011-09-05): Control of tracheal cuff pressure may cut ventilator-associated pneumonia

Clinical

Control of tracheal cuff pressure may cut ventilator-associated pneumonia

Last Updated: 2011-09-05 12:10:21 -0400 (Reuters Health)

NEW YORK (Reuters Health) - In critically ill patients on mechanical ventilation, continuous control of tracheal cuff pressure using a pneumatic device reduces microaspiration of gastric contents and the incidence of ventilator-associated pneumonia (VAP), according to a randomized study from France.

In an e-mail to Reuters Health, Dr. Saad Nseir, of the Intensive Care Unit at Calmette Hospital in Lille, said, "Implementation of this measure should now be considered in ICUs with high VAP rates."

In an article in the American Journal of Respiratory and Critical Care Medicine, published online August 11, Dr. Nseir and colleagues note that under- and over-inflation of the tracheal cuff are common. Both are established risk factors for microaspiration of contaminated oropharyngeal secretions and gastric contents and VAP.

Dr. Nseir and colleagues determined the impact of continuous control of tracheal cuff pressure on microaspiration of gastric contents in 122 patients expected to receive mechanical ventilation for at least 48 hours through a tracheal tube.

They randomly allocated 61 to continuous control of tracheal cuff pressure using a pneumatic device (Nosten, Leved, St-Maur, France) and 61 to routine care of tracheal cuff pressure.

The pneumatic device provided good control of tracheal cuff pressure, the investigators say. In addition, the percentage of patients with abundant microaspiration (defined by pepsin in tracheal aspirates) was significantly lower in those managed this way (18% vs. 46% in the control group; p=0.002).

Bacterial concentration in tracheal aspirates was also significantly lower in the intervention group (1.6 vs. 3.7 log10 cfu/mL; p=0.014), as was the rate of VAP (10% vs. 26%; p=0.032).

Continuous control of tracheal cuff pressure had no significant effect on the incidence of tracheal ischemic lesions.

"Randomized controlled multicenter studies," Dr. Nseir said, "are needed to confirm our results and to evaluate cost-effectiveness and the long-term effect of continuous control of cuff pressure on tracheal ischemic lesions before generalizing the use of this technique in every intubated patient requiring mechanical ventilation."

In the meantime, Dr. Nseir and colleagues think this approach should be considered in ICUs where VAP is a problem.

Dr. Nseir reports financial ties to Covidien.

SOURCE: http://bit.ly/qMJb4O

Am J Respir Crit Care Med 2011.

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