Impacto da aspiração supra-cuff na prevenção da pneumonia associada à ventilação mecânica

Abstract

Critically ill patients are intubated or tracheostomized because, in most cases, these individuals require invasive mechanical ventilation. The cannulae that are used include the cuff, which can act as a reservoir for oropharyngeal secretions, predisposing to ventilator-associated pneumonia. Studies have revealed that the suction of subglottic secretions through the dorsal suction lumen above the endotracheal tube cuff delays the onset and reduces the incidence of ventilator-associated pneumonia. The aim of this review is to assess published studies regarding the significance of using suction with a supra-cuff device for the prevention of ventilator-associated pneumonia in critically ill patients treated with orotracheal intubation or tracheostomy. Therefore, by searching national and international databases, a literature review was undertaken of studies published between the years 1986 and 2011. Few results were found relating the suction of subglottic secretions to decreased duration of mechanical ventilation and length of stay in the intensive care unit. The suction of subglottic secretions is ineffective in decreasing mortality but is effective in reducing the incidence of early-onset ventilator-associated pneumonia and hospital costs. Techniques involving continuous suction of subglottic secretions may be particularly efficient in removing secretions; however, intermittent suction appears to be the least harmful method. In conclusion, cannulae with a supra-cuff suction device enable the aspiration of subglottic secretions, providing benefits to critically ill patients by reducing the incidence of ventilator-associated pneumonia and, consequently, hospital costs - with no large-scale adverse effects.

Frequency and characterization of the use of cuffed tracheal tubes in neonatal and pediatric intensive care units in Brazil

“…Studies (32.33) on adult patients have shown that a cuff pressure above 20cmH 2 O is desirable for preventing the aspiration of contaminated supraglottic secretions and, consequently, preventing ventilator-associated pneumonia (VAP). ( 34 ) The frequency of lower airway microaspiration is higher in children on MV due to a longer ventilation duration, the absence of a tracheal cuff, younger chronological age, bronchopulmonary dysplasia and the presence of tracheostomy. ( 3 ) No studies were found describing the minimum pressure required to avoid the aspiration of supraglottic secretions into the lower airway in children.…”

Efetividade Das Medidas De Prevenção E Controle De Pneumonia Associada À Ventilação Mecânica Na Uti

“…Souza;Santana (2012) apontam que o tubo orotraqueal e a cânula de traqueostomia ambos apresentam o cuff, balonete indicado para vedar as vias aéreas inferiores durante a ventilação mecânica, o qual deve ser aferido a cada quatro horas e mantido insuflado com uma pressão ideal de 20 a 25 cmH2O, visto que, a pressão superior pode levar a lesão da parede traqueal, a pressão inferior pode ocasionar broncoaspiração e consequentemente o desenvolvimento da PAVM.…”

Measurement reliability of endotracheal tubes cuff pressure between industrial and handmade devices

“…In this sense, Peña et al (3) argue that this pressure keep between 25 to 34 cmH 2 O with a minimum limit of 20 cmH 2 O to prevent air leakage and bronchoaspiration. Souza and Santana (16) argue that the cuff should be kept inflated with an ideal pressure of 20 to 30 cmH 2 O, to prevent any bronchoaspiration, using a lower pressure, and damage to the tracheal wall, in the use of a higher pressure. However, there is no agreement to the maximum pressure value in the cuff of the endotracheal tube to avoid injury.…”