Inappropriate Endotracheal Tube (ETT) cuff pressure and its relation to ventilator-associated pneumonia (VAP) in Intensive care unit (ICU)

Abstract

Purpose: The respiratory therapist has a major role in preventing nosocomial infection in ICU. One of the most common infections with mechanically ventilated patients is VAP. Inappropriate ETT Cuff measure is one of the main risk factors for microaspiration and VAP. To help reduce this issue, we aimed to observe and investigate medical errors during respiratory therapy in ICU. Methods: An observational study conducted done by three trained researchers over a period of 65 days, in two ICUs with total of 56 ICU Beds capacity. The observational study was followed by 20 semi-structured interviews with the staff of respiratory therapy department in each ICU to explore their understanding of the observed incidents and the contributing factors. All discussions and detailed notes taken were transcribed, qualitatively analyzed using line by line coding and then synthesized into narrative themes. We used NVivo-11 to organize and manage the data. Results: During the observational periods, a total of twenty-four patients developed VAP. Among these patients eight patients (33%) were exposed to inappropriate ETT cuff pressure. No fatality was reported as a result of VAP until the study was concluded. Conclusions: Patient’s with ETT cuff pressures which are outside the recommended range may be at increased risk of developing VAP and further complications. Poor cuff pressure management could increase ICU days and prolong the use of mechanical ventilation. Clinical Implications: We recommended that the staff be educated about the consequences of poor cuff pressure management and the complications which may arise as a result.