Automatic regulation of the endotracheal tube cuff pressure with a portable elastomeric device. A randomized controlled study

Abstract

Background Endotracheal tube cuff underinflation contributes to microaspiration of contaminated oropharyngeal content, source of pneumonia. Overinflation exposes to airway damage. Intermittent manual adjustment of the cuff pressure (P cuff ) may delay the detection of under- or overinflation. Devices for automated continuous adjustment of P cuff are promising but some are inconvenient, expensive or even harmful. This prospective randomized controlled study tested whether the Tracoe Smart Cuff Manager TM reduced the rate of patients undergoing ≥1 episode of underinflation (P cuff <20 cmH 2 O), as compared with routine manual P cuff adjustment. Secondary endpoints included comparisons of the rate of patients with ≥1 overinflation episode (P cuff >30 cmH 2 O), of the incidence of under- and overinflation episodes and of their magnitude. Methods Patients likely to receive invasive mechanical ventilation for >48 hours because of acute brain injury were randomly allocated to receive, during 48 hours, automated P cuff adjustment (combined with manual adjustment) or manual adjustment alone. In each group, P cuff was measured with a dedicated manual manometer, at least every 8 hours. Results Sixty patients were analyzed (28 patients with automated and 32 with manual P cuff adjustment) for 506 measurements of P cuff (237 and 269, respectively). As compared with manual adjustment, automated adjustment of P cuff was associated with 1) a lower rate of patients with ≥1 episode of underinflation (63% and 18%, respectively, p<0.001), 2) a lower incidence of underinflation episodes (15% vs. 2%;p<0.001), 3) a lower rate of manual adjustments (77% vs. 56%;p<0.001) and 4) manual adjustments of lower magnitude (5.9±4.5 vs. 3.6±4.7 cmH 2 O;p<0.001). For overinflation, there was no significant between-groups differences (p>0.99). Conclusions The adjunction of a continuous P cuff control with the Tracoe Smart Cuff Manager TM to routine manual intermittent adjustment reduced both the incidence of P cuff underinflation episodes and their magnitude without provoking overinflation.

Regulation of Tracheal Cuff Pressure

“…In our opinion, the findings of Marjanovic et al 1 may not apply to less cumbersome devices, that is, devices less frequently disconnected. 4 Last, if future studies confirm that continuous and intermittent regulation of tracheal cuff pressure are equivalent in preventing VAP, this would question the main component of the current paradigm of VAP pathophysiologic condition (aspiration of oropharyngeal content) and encourage the exploration of other pathways. 5 Karim Lakhal, MD Jérôme E. Dauvergne…”