Continuous endotracheal tube cuff pressure control system protects against ventilator-associated pneumonia.

Leonardo Lorente,María L Mora,Celina Llanos,Lisset Lorenzo,Judith Cabrera,Alejandro Jiménez,Isabel Roca,María Lecuona

doi:10.1186/cc13837

Leonardo Lorente, María L Mora + Show 6 more

Open Access

https://doi.org/10.1186/cc13837

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Journal: Critical Care	Publication Date: Jan 1, 2014
Citations: 88	License type: cc-by

Affiliation: Hospital Universitario de Canarias

Abstract

IntroductionThe use of a system for continuous control of endotracheal tube cuff pressure reduced the incidence of ventilator-associated pneumonia (VAP) in one randomized controlled trial (RCT) with 112 patients but not in another RCT with 142 patients. In several guidelines on the prevention of VAP, the use of a system for continuous or intermittent control of endotracheal cuff pressure is not reviewed. The objective of this study was to compare the incidence of VAP in a large sample of patients (n = 284) treated with either continuous or intermittent control of endotracheal tube cuff pressure.MethodsWe performed a prospective observational study of patients undergoing mechanical ventilation during more than 48 hours in an intensive care unit (ICU) using either continuous or intermittent endotracheal tube cuff pressure control. Multivariate logistic regression analysis (MLRA) and Cox proportional hazard regression analysis were used to predict VAP. The magnitude of the effect was expressed as odds ratio (OR) or hazard ratio (HR), respectively, and 95% confidence interval (CI).ResultsWe found a lower incidence of VAP with the continuous (n = 150) than with the intermittent (n = 134) pressure control system (22.0% versus 11.2%; p = 0.02). MLRA showed that the continuous pressure control system (OR = 0.45; 95% CI = 0.22-0.89; p = 0.02) and the use of an endotracheal tube incorporating a lumen for subglottic secretion drainage (SSD) (OR = 0.39; 95% CI = 0.19-0.84; p = 0.02) were protective factors against VAP. Cox regression analysis showed that the continuous pressure control system (HR = 0.45; 95% CI = 0.24-0.84; p = 0.01) and the use of an endotracheal tube incorporating a lumen for SSD (HR = 0.29; 95% CI = 0.15-0.56; p < 0.001) were protective factors against VAP. However, the interaction between type of endotracheal cuff pressure control system (continuous or intermittent) and endotracheal tube (with or without SSD) was not statistically significant in MLRA (OR = 0.41; 95% CI = 0.07-2.37; p = 0.32) or in Cox analysis (HR = 0.35; 95% CI = 0.06-1.84; p = 0.21).ConclusionsThe use of a continuous endotracheal cuff pressure control system and/or an endotracheal tube with a lumen for SSD could help to prevent VAP in patients requiring more than 48 hours of mechanical ventilation.

Highlights

The use of a system for continuous control of endotracheal tube cuff pressure reduced the incidence of ventilator-associated pneumonia (VAP) in one randomized controlled trial (RCT) with 112 patients but not in another RCT with 142 patients
There were no significant differences between the two groups of patients (150 with the intermittent and 134 with continuous cuff-pressure control system) in terms of sex, age, smoking status, chronic obstructive pulmonary disease, diabetes mellitus, chemotherapeutic agents, steroid agents, hematological tumor, solid tumor, diagnosis group, Acute Physiology and Chronic Health Evaluation (APACHE)-II score, duration of mechanical ventilation, antibiotics prior to VAP onset, use of paralytic agents, tracheotomy, reintubation, enteral nutrition, subglottic secretion drainage (SSD) or intensive care unit (ICU) mortality (Table 1)
Multivariate logistic regression analysis showed that the continuous pressure control system (OR = 0.45, 95% confidence interval (CI) = 0.22, 0.89, P = 0.02) and the use of an endotracheal tube incorporating a lumen for subglottic secretion drainage (OR = 0.39; 95% CI = 0.19, 0.84; P = 0.02) were protective factors against VAP (Table 2)

Summary

Introduction

The use of a system for continuous control of endotracheal tube cuff pressure reduced the incidence of ventilator-associated pneumonia (VAP) in one randomized controlled trial (RCT) with 112 patients but not in another RCT with 142 patients. In one randomized controlled trial (RCT) published in 2007, which included 142 mechanically ventilated patients, there were no significant differences in the incidence of VAP between groups treated with a continuous or an intermittent endotracheal-tube cuff-pressure control system [10]. Another RCT published in 2011, with 122 patients expected to receive mechanical ventilation for at least 48 hours, found a lower incidence of VAP with the use of a continuous compared to an intermittent endotracheal-tube cuff-pressure control system [11]. Other guidelines only recommend maintaining optimal tube cuff-pressure but make no recommendations on the use of a continuous or intermittent tube cuff-pressure control system [16,17,18,19]

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