Abstract
BackgroundUnderinflation of tracheal cuff is a risk factor for microaspiration of contaminated secretions and subsequent ventilator-associated pneumonia (VAP). The aim of this collaborative meta-analysis of individual participant data is to determine the impact of continuous control of Pcuff on the incidence of VAP.MethodsStudies were identified by searching PubMed and references of relevant articles. Data from 3 prospective controlled trials (two randomized and one quasi-randomized), which evaluated the impact of continuous control of Pcuff on the incidence of VAP, were obtained and pooled together. Three different devices were used to continuously control Pcuff. VAP was diagnosed using clinical, radiologic, and quantitative microbiological criteria. The impact of continuous control of Pcuff on VAP was assessed by Cox regression analysis, stratified on trial.Results263 (48.4 %) patients received continuous control of Pcuff, and 280 (51.5 %) patients received routine control of Pcuff using a manometer. 36 (13.6 %) VAP were diagnosed in continuous control group, and 72 (25.7 %) in routine care group (HR 0.47, 95 % CI 0.31–0.71, p < 0.001). However, heterogeneity was apparent in continuous control effect size across trials (I2 = 58 %, p = 0.085). The number of patients needed to treat to prevent one VAP episode was 8. No significant impact of continuous control of Pcuff was found on duration of mechanical ventilation, ICU length of stay, or mortality.ConclusionContinuous control of Pcuff might be beneficial in reducing the risk for VAP. However, no significant impact of continuous control of Pcuff was found on duration of mechanical ventilation, ICU length of stay, or mortality.
Highlights
Underinflation of tracheal cuff is a risk factor for microaspiration of contaminated secretions and subsequent ventilator-associated pneumonia (VAP)
Search for eligible trials We identified clinical prospective clinical trials that compared the continuous control of Cuff pressure (Pcuff) and routine care regarding the incidence of VAP
Among the 7 remaining studies, 2 were excluded because Pcuff control was not continuous, and 2 because other concomitant preventive measures were used in the intervention group (Fig. 1)
Summary
Underinflation of tracheal cuff is a risk factor for microaspiration of contaminated secretions and subsequent ventilator-associated pneumonia (VAP). The aim of this collaborative meta-analysis of individual participant data is to determine the impact of continuous control of Pcuff on the incidence of VAP. Prevention of ventilator-associated pneumonia (VAP) is an important strategy to improve the quality of care provided to critically ill patients [1,2,3]. Several measures have been studied for prevention of microaspiration in intubated critically ill patient. These could be classified into enteral nutrition, mechanical ventilation, tracheal tube, and patient-related factors [13]. A recent randomized controlled multicenter study did not report any significant impact of these measures regarding the rate of tracheobronchial colonization, or VAP [16]
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