Efficiency of a mechanical device in controlling tracheal cuff pressure in intubated critically ill patients : a randomized controlled study
Nseir, Saad (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Rodriguez, Andrey (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Saludes, Paula (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
De Jonckheere, Julien (University Hospital of Lille (França))
Valles, Jordi (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Artigas, Antonio (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Martin-Loeches, Ignacio (St James's University Hospital)

Data:	2015
Resum:	Cuff pressure (P ) control is mandatory to avoid leakage of oral secretions passing the tracheal tube and tracheal ischemia. The aim of the present trial was to determine the efficacy of a mechanical device (PressureEasy®) in the continuous control of P in patients intubated with polyvinyl chloride (PVC)-cuffed tracheal tubes, compared with routine care using a manometer. This is a prospective, randomized, controlled, cross-over study. All patients requiring intubation with a predicted duration of mechanical ventilation ≥48 h were eligible. Eighteen patients randomly received continuous control of P with PressureEasy® device for 24 h, followed by discontinuous control (every 4 h) with a manual manometer for 24 h, or vice versa. P and airway pressure were continuously recorded. P target was 25 cmHO during the two periods. The percentage of time spent with P 20-30 cmHO (median (IQR) 34 % (17-57) versus 50 % (35-64), p = 0. 184) and the percentage of time spent with P <20 cmHO (23 % (5-63) versus 43 % (16-60), p = 0. 5) were similar during continuous control of P and routine care, respectively. However, the percentage of time spent with P >30 cmHO was significantly higher during continuous control compared with routine care of tracheal cuff (26 % (14-39) versus 7 % (1-18), p = 0. 002). No significant difference was found in P (25 (18-28) versus 21 (18-26), p = 0. 17), mean airway pressure (14 (10-17) versus 14 (11-16), p = 0. 679), or coefficient of variation of P (19 % (11-26) versus 20 % (11-25), p = 0. 679) during continuous control compared with routine care of tracheal cuff, respectively. PressureEasy® did not demonstrate a better control of P between 20 and 30 cmHO, compared with routine care using a manometer. Moreover, the device use resulted in significantly higher time spent with overinflation of tracheal cuff, which might increase the risk for tracheal ischemic lesions.
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Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Cuff pressure ; Control ; Tracheal ischemia ; Microaspiration ; Mechanical ventilation
Publicat a:	Annals of Intensive Care, Vol. 5 (june 2015) , ISSN 2110-5820

DOI: 10.1186/s13613-015-0054-z
PMID: 26059205

7 p, 786.0 KB

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