Efficiency of a mechanical device in controlling tracheal cuff pressure in intubated critically ill patients: a randomized controlled study

Saad Nseir, Andrey Rodriguez, Paula Saludes, Julien De Jonckheere, Jordi Valles, Antonio Artigas, Ignacio Martin-Loeches

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8 Citations (Scopus)

Abstract

© 2015, Nseir et al. Background: Cuff pressure (P<inf>cuff</inf>) 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<inf>cuff</inf> in patients intubated with polyvinyl chloride (PVC)-cuffed tracheal tubes, compared with routine care using a manometer. Methods: 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<inf>cuff</inf> with PressureEasy® device for 24 h, followed by discontinuous control (every 4 h) with a manual manometer for 24 h, or vice versa. P<inf>cuff</inf> and airway pressure were continuously recorded. P<inf>cuff</inf> target was 25 cmH<inf>2</inf>O during the two periods. Results: The percentage of time spent with P<inf>cuff</inf> 20–30 cmH<inf>2</inf>O (median (IQR) 34 % (17–57) versus 50 % (35–64), p = 0.184) and the percentage of time spent with P<inf>cuff</inf> <20 cmH<inf>2</inf>O (23 % (5–63) versus 43 % (16–60), p = 0.5) were similar during continuous control of P<inf>cuff</inf> and routine care, respectively. However, the percentage of time spent with P<inf>cuff</inf> >30 cmH<inf>2</inf>O 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<inf>cuff</inf> (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<inf>cuff</inf> (19 % (11–26) versus 20 % (11–25), p = 0.679) during continuous control compared with routine care of tracheal cuff, respectively. Conclusions: PressureEasy® did not demonstrate a better control of P<inf>cuff</inf> between 20 and 30 cmH<inf>2</inf>O, 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. Trial registration: Clinicaltrial.gov: NCT02109003
Original languageEnglish
Article number12
JournalAnnals of Intensive Care
Volume5
Issue number1
DOIs
Publication statusPublished - 11 Dec 2015

Keywords

  • Control
  • Cuff pressure
  • Mechanical ventilation
  • Microaspiration
  • Tracheal ischemia

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