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Abstract
BackgroundDespite intermittent control of tracheal cuff pressure (P cuff) using a manual manometer, cuff underinflation (<20 cmH2O) and overinflation (>30 cmH2O) frequently occur in intubated critically ill patients, resulting in increased risk of microaspiration and tracheal ischemic lesions. The primary objective of our study was to determine the efficiency of an electronic device in continuously controlling P cuff. The secondary objective was to determine the impact of this device on the occurrence of microaspiration of gastric or oropharyngeal secretions.MethodsEighteen patients requiring mechanical ventilation were included in this prospective randomized controlled crossover study. They randomly received either continuous control of P cuff with Mallinckrodt® device for 24 h, followed by discontinuous control with a manual manometer for 24 h, or the reverse sequence. During the 48 h after randomization, P cuff was continuously recorded, and pepsin and alpha amylase were quantitatively measured in tracheal aspirates. P cuff target was 25 cmH2O.ResultsClinical characteristics were similar during the two study periods, as well as mean airway pressure. Percentage of time spent with cuff overinflation or underinflation was significantly lower during continuous control compared with routine care period [median (IQR) 0.8 (0.1, 2) vs 20.9 (3.1, 40.1), p = 0.0009]. No significant difference was found in pepsin [median (IQR) 230 (151, 300) vs 259 (134, 368), p = 0.95] or in alpha amylase level [median (IQR) 1475 (528, 10,333) vs 2400 (1342, 15,391), p = 0.19] between continuous control and routine care periods, respectively.ConclusionsThe electronic device is efficient in controlling P cuff, compared with routine care using a manometer. Further studies are needed to evaluate the impact of this device on intubation-related complications. Trial registration ClinicalTrials.gov Identifier: NCT01965821
Highlights
Despite intermittent control of tracheal cuff pressure (Pcuff) using a manual manometer, cuff under‐ inflation (30 cmH2O) frequently occur in intubated critically ill patients, resulting in increased risk of microaspiration and tracheal ischemic lesions
The secondary objective of this study was to evaluate the impact of continuous control of Pcuff, using the electronic device, on microaspiration of gastric contents in intubated critically ill patients
Our results suggest that the electronic device is efficient in controlling Pcuff
Summary
Despite intermittent control of tracheal cuff pressure (Pcuff) using a manual manometer, cuff under‐ inflation (30 cmH2O) frequently occur in intubated critically ill patients, resulting in increased risk of microaspiration and tracheal ischemic lesions. In spite of the increased use of noninvasive ventilation and high-flow nasal oxygen [1,2,3], intubation is still frequently performed in up to 85 % of critically ill patients requiring mechanical ventilation [4]. This invasive procedure is associated with several potential complications, Current recommendations are to keep cuff pressure (Pcuff) between 20 and 30 cmH2O, using a manometer [12]. Many devices are available on the market, few of them were evaluated and validated by well-conducted clinical studies These devices could be classified into mechanical and electronic. The advantages in using an electronic device are its easy use and the lower cost, compared with a pneumatic device
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