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Crit Care Med. 2007 Jun;35(6):1543-9.

Automatic control of tracheal tube cuff pressure in ventilated patients in semirecumbent position: a randomized trial.

Author information

1
Unitat de Cures Intensives I Interm├Ędies, Servei de Pneumologia, Institut Clinic del Torax, Hospital Clinic, Barcelona, Spain.

Abstract

OBJECTIVE:

The aspiration of subglottic secretions colonized by bacteria pooled around the tracheal tube cuff due to inadvertent deflation (<20 cm H2O) of the cuff plays a relevant role in the pathogenesis of ventilator-associated pneumonia. We assessed the efficacy of an automatic, validated device for the continuous regulation of tracheal tube cuff pressure in preventing ventilator-associated pneumonia.

DESIGN:

Prospective randomized controlled trial.

SETTING:

Respiratory intensive care unit and general medical intensive care unit.

PATIENTS:

One hundred and forty-two mechanically ventilated patients (age, 64 +/- 17 yrs; Acute Physiology and Chronic Health Evaluation II score, 18 +/- 6) without pneumonia or aspiration at admission.

INTERVENTIONS:

Within 24 hrs of intubation, patients were randomly allocated to undergo continuous regulation of the cuff pressure with the automatic device (n = 73) or routine care of the cuff pressure (control group, n = 69). Patients remained in a semirecumbent position in bed.

MEASUREMENTS AND MAIN RESULTS:

The primary end point variable was the incidence of ventilator-associated pneumonia. Main causes for intubation were decreased consciousness (43, 30%) and exacerbation of chronic respiratory diseases (38, 27%). Cuff pressure <20 cm H2O was more frequently observed in the control than the automatic group (45.3 vs. 0.7% determinations, p < .001). However, the rate of ventilator-associated pneumonia with clinical criteria (16, 22% vs. 20, 29%) and microbiological confirmation (11, 15% vs. 10, 15%), the distribution of early and late onset, the causative microorganisms, and intensive care unit (20, 27% vs. 16, 23%) and hospital mortality (30, 41% vs. 23, 33%) were similar for the automatic and control groups, respectively.

CONCLUSIONS:

Cuff pressure is better controlled with the automatic device. However, it did not result in additional benefits to the semirecumbent position in preventing ventilator-associated pneumonia.

[Indexed for MEDLINE]

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