Minimal Occlusive Volume Research Articles

Prospective research of ventilator-associated pneumonia caused by the aerocyst continual inflation and clocked deflation

Objective To explore the relationship between the aerocyst continual inflation and clocked deflation and ventilator-associated pneumonia. Methods 60 ICU hospitalized adult patients treated with tracheotomy or trachea canalization for above 24 hours were randomly divided into the tzadi-tional group and the experimental group with 30 patients in each group. After trachea canalization success-fully according to the nursing standard, the experimental group was treated with aerocyst continual inflation, the traditional group gased the ventilator and recorded the time, deflating the gas every 4 hours and inflating again after 5 minutes. The inflation time, nurse management and MOV(minimal occlusive volume)of the two groups were the same. The chest X-rays examination and deep sputum bacilli culture were implemented 12 hours after admission, before pulling out the ventilator and transferring out of ICU to evaluate the inci-dence of ventilator-associated pneumonia according to the infection diagnosis standard. Results The rate of ventilator-associated pneumonia in the experimental group was obviously lower than that of the tradition-al group. Conclusions The rate of ventilator-associated pneumonia reduces obviously in the ICU trachea canalization patients with aerocyst continual inflation. Key words: Continual inflation; Pneumonia; Ventilator-associated; Infection control

Survey of Cuff Management Practices in Intensive Care Units in Australia and New Zealand

Cuff management varies widely in Europe and North America. Little is known about current practice in Australia and New Zealand. To characterize important aspects of cuff management in intensive care units in Australia and New Zealand to compare with international reports. A questionnaire was sent to all nurse managers of adult intensive care units in Australia and New Zealand. Survey response was 53% (92/175). After intubation, most units (50/92, 54%) used both minimal occlusive volume technique and cuff pressure measurement; 5 (5.5%) used these methods along with pilot balloon palpation. Twenty units (22%) used cuff pressure measurement exclusively and 16 units (17.5%) used the minimal occlusive volume technique exclusively. Only 1 unit (1%) used the minimal leak technique after intubation. For ongoing management, cuff pressure measurement was the preferred method, used exclusively in 42 units (46%), with the minimal occlusive volume technique used in 40 units (43%; sole method in 6 units [7%]) and palpation in 4 units (4%). In most units (65/92, 71%), cuffs were monitored once per nursing shift. In units using the minimal occlusive volume technique, oropharyngeal suctioning (74%) and semirecumbent positioning (58%) were routinely incorporated; sigh breaths (6%), discontinuation of enteral feeding (10%), and nasogastric tube aspiration (26%) were uncommon. Cuff management protocols (37%) and subglottic suctioning (12%) were used infrequently. Cuff pressure measurement was the preferred method, used exclusively or in combination with other methods. The minimal occlusive volume technique was used more often after intubation than for ongoing management.

Minimal occlusive volume cuff inflation: A survey of current practice

To describe the minimal occlusive volume (MOV) procedure used to monitor cuff inflation and identify practice variation. Self-administered questionnaire. Adult intensive care unit in an Australian university-affiliated hospital. Survey response was 71% (80/113). Three methods of MOV were identified. Full cuff deflation, followed by reinflation, removal of 1mL increments of air until a leak was detected, then restoration of cuff seal with 1mL of air was the preferred method (47/80 respondents, 59%) (Method 1). Full cuff deflation followed by incremental addition of air until the MOV was established was used by 25/80 (31%) respondents (Method 2). Two (2.5%) nurses established MOV without full cuff deflation (Method 3), five (6.25%) used more than one method and one (1.25%) nurse did not perform cuff checks. Practice variation was identified for patient positioning, confirmation of cuff seal, and cuff leak management. Consistency of practice was noted in MOV procedure frequency, the number of nurses required, pre-oxygenation and oropharyngeal suctioning prior to cuff deflation. Substantial practice variation for certain aspects of cuff management was noted. Evidence to support the efficacy of MOV procedural elements is required to limit practice variation and reduce risk to patients.

Airway Management

Airway Management

Artificial airways: A survey of cuff management practices

To determine current endotracheal and tracheostomy tube cuff management practices in adult and pediatric populations, and to compare current adult cuff management practice with those reported in use in 1984 and 1987. Descriptive survey. Sixty-four acute care hospitals in the northeastern United States. Responders represented 93 critical care units: 59 adult and 34 pediatric units. Subjects completed a survey questionnaire. Forty-one percent reported cuffs were routinely deflated, with most (88%) reporting cuff deflation every 8 to 12 hours or daily. In the pediatric population, minimal occlusive volume was the most frequent technique (29%); whereas in the adult population, both minimal occlusive volume technique and minimal leak technique were used more frequently (36%). Most (93%) cuff pressures were measured every 8 to 12 hours or daily with a recommended maximum range of 20 to 30 mm Hg. Cuff deflation and cuff inflation were performed more often by the nursing staff (36%). Cuff pressures were performed more often by respiratory staff (71%). There were no statistically significant differences in the cuff management practices between the adult and pediatric populations. In comparing the results for adults to the data of 1984 and 1987, most cuff management practices changed from every 8 hours or less to every 8 to 12 hours or daily, and the nursing responsibility for these techniques increased (22%). Most responders do not routinely deflate cuffs. Cuff management practices are performed less frequently, and nursing responsibility for these techniques has increased.

DELAYED LUMEN OBSTRUCTION IN ENDOTRACHEAL TUBES

Delayed onset of obstruction in the Oxford endotracheal tube during anaesthesia is described in five patients. The effects of intra-cuff voluem and pressure on the wall of the tube were investigated and discussed with special refernce to the ffects of body heat and repeated use on the consistency of the tube. It is concluded that inward collapse of the tube wall is caused by a combination of factors, namely: frequent use, softening of the tube wall by body heat, the gradual increasing of intra-cuff volume and pressure by diffusion of nitrous oxide into the cuff, replacing a damaged cuff by a new one and heat sterilization. Deflation and re-inflation of the cuff to minimal occlusive volume at hourly intervals is suggested as a precautionary measure in the prevention of inward collapse of the tube wall.