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

doi:https://doi.org/10.1186/s13613-015-0054-z

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

Department of Medicine

Research output: Contribution to journal › Article › Research › peer-review

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 language	English
Article number	12
Journal	Annals of Intensive Care
Volume	5
Issue number	1
DOIs	https://doi.org/10.1186/s13613-015-0054-z
Publication status	Published - 11 Dec 2015

Keywords

Control
Cuff pressure
Mechanical ventilation
Microaspiration
Tracheal ischemia

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@article{43278dc899c646c3bf3c755dcd01d035,

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

abstract = "{\textcopyright} 2015, Nseir et al. Background: Cuff pressure (Pcuff) 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{\textregistered}) in the continuous control of Pcuff 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 Pcuff with PressureEasy{\textregistered} device for 24 h, followed by discontinuous control (every 4 h) with a manual manometer for 24 h, or vice versa. Pcuff and airway pressure were continuously recorded. Pcuff target was 25 cmH2O during the two periods. Results: The percentage of time spent with Pcuff 20–30 cmH2O (median (IQR) 34 % (17–57) versus 50 % (35–64), p = 0.184) and the percentage of time spent with Pcuff <20 cmH2O (23 % (5–63) versus 43 % (16–60), p = 0.5) were similar during continuous control of Pcuff and routine care, respectively. However, the percentage of time spent with Pcuff >30 cmH2O 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 Pcuff (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 Pcuff (19 % (11–26) versus 20 % (11–25), p = 0.679) during continuous control compared with routine care of tracheal cuff, respectively. Conclusions: PressureEasy{\textregistered} did not demonstrate a better control of Pcuff between 20 and 30 cmH2O, 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",

keywords = "Control, Cuff pressure, Mechanical ventilation, Microaspiration, Tracheal ischemia",

author = "Saad Nseir and Andrey Rodriguez and Paula Saludes and {De Jonckheere}, Julien and Jordi Valles and Antonio Artigas and Ignacio Martin-Loeches",

year = "2015",

month = dec,

day = "11",

doi = "https://doi.org/10.1186/s13613-015-0054-z",

language = "English",

volume = "5",

number = "1",

}

Efficiency of a mechanical device in controlling tracheal cuff pressure in intubated critically ill patients: a randomized controlled study. / Nseir, Saad; Rodriguez, Andrey; Saludes, Paula; De Jonckheere, Julien; Valles, Jordi; Artigas, Antonio; Martin-Loeches, Ignacio.

In: Annals of Intensive Care, Vol. 5, No. 1, 12, 11.12.2015.

Research output: Contribution to journal › Article › Research › peer-review

TY - JOUR

T1 - Efficiency of a mechanical device in controlling tracheal cuff pressure in intubated critically ill patients: a randomized controlled study

AU - Nseir, Saad

AU - Rodriguez, Andrey

AU - Saludes, Paula

AU - De Jonckheere, Julien

AU - Valles, Jordi

AU - Artigas, Antonio

AU - Martin-Loeches, Ignacio

PY - 2015/12/11

Y1 - 2015/12/11

N2 - © 2015, Nseir et al. Background: Cuff pressure (Pcuff) 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 Pcuff 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 Pcuff with PressureEasy® device for 24 h, followed by discontinuous control (every 4 h) with a manual manometer for 24 h, or vice versa. Pcuff and airway pressure were continuously recorded. Pcuff target was 25 cmH2O during the two periods. Results: The percentage of time spent with Pcuff 20–30 cmH2O (median (IQR) 34 % (17–57) versus 50 % (35–64), p = 0.184) and the percentage of time spent with Pcuff <20 cmH2O (23 % (5–63) versus 43 % (16–60), p = 0.5) were similar during continuous control of Pcuff and routine care, respectively. However, the percentage of time spent with Pcuff >30 cmH2O 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 Pcuff (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 Pcuff (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 Pcuff between 20 and 30 cmH2O, 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

AB - © 2015, Nseir et al. Background: Cuff pressure (Pcuff) 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 Pcuff 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 Pcuff with PressureEasy® device for 24 h, followed by discontinuous control (every 4 h) with a manual manometer for 24 h, or vice versa. Pcuff and airway pressure were continuously recorded. Pcuff target was 25 cmH2O during the two periods. Results: The percentage of time spent with Pcuff 20–30 cmH2O (median (IQR) 34 % (17–57) versus 50 % (35–64), p = 0.184) and the percentage of time spent with Pcuff <20 cmH2O (23 % (5–63) versus 43 % (16–60), p = 0.5) were similar during continuous control of Pcuff and routine care, respectively. However, the percentage of time spent with Pcuff >30 cmH2O 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 Pcuff (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 Pcuff (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 Pcuff between 20 and 30 cmH2O, 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

KW - Control

KW - Cuff pressure

KW - Mechanical ventilation

KW - Microaspiration

KW - Tracheal ischemia

UR - https://ddd.uab.cat/record/185348

U2 - https://doi.org/10.1186/s13613-015-0054-z

DO - https://doi.org/10.1186/s13613-015-0054-z

M3 - Article

VL - 5

IS - 1

M1 - 12

ER -

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

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Keywords

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