Effects of continuous artificial airway cuff pressure monitoring in preventing ventilator-associated pneumonia

Abstract

Objective To investigate the effects of different control methods in cuff pressure (Pcuff) on the incidence of ventilator associated pneumonia (VAP) for the patient receiving mechanical ventilation with implication of artificial airway by oral endotracheal intubation. Methods A total of 80 patients receiving mechanical ventilation with oral endotracheal were numbered according to the order of using mechanical ventilation. Patients with odd numbers were recruited into intervention group (40 cases) , while patients with even numbers were included in control group (40 cases) . Patients in intervention group used Arto continuous air pressure control device to continuously control the cuff pressure, while the control group used German VBM airbags pressure gauge to measure and regulate cuff pressure three times a day. Sputum specimens of patients were taken and pepsin levels were tested at tracheal intubation, 48 h and 96 h post mechanical ventilation. Pcuff, pepsin levels in sputum specimens and the incidence of VAP were compared between two groups. Results At 96 h post mechanical ventilation, Pcuff of patients in intervention group were in the ideal range (20~30cmH2O) for 479 times, and in control group the number were 389 times. The difference was statistically significant (χ2=124.830, P<0.01) . The pepsin levels of sputum specimens in intervention group were (617.32±67.13) and (653.13±71.32) ng/ml at 48 h and 96 h post mechanical ventilation, both of which were significantly lower than those in control group (t=-11.217, -14.500; P<0.01) . The incidences of VAP were 25.0% and 47.5% in intervention and control group respectively, with statistically significant difference between two groups (χ2=4.381, P<0.05) . Conclusions The continuous air pressure control device can better keep the air pressure in the ideal range and reduce gastric contents aspiration of the patients with mechanical ventilation so as to reduce the incidence of VAP. Key words: Ventilator-associated pneumonia; Pepsin; Misaspiration; Continuous artificial airway; Cuff pressure