Frequent Versus Infrequent Monitoring of Endotracheal Tube Cuff Pressures

Letvin, Adam N.; Kremer, Pamala; Silver, Patricia; Samih, Nizama; Reed-Watts, Peggy; Kollef, Marin H.

doi:10.4187/respcare.05926

Cited by 37 publications

(35 citation statements)

References 24 publications

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“…A potential future workup process will be to use multiplex PCR (blue box) to identify within less than 6 h pathogens responsible for VAP and their resistance to antimicrobials chloride at preventing VAP or improving objective outcomes [101][102][103][104]. Likewise, manually monitoring cuff pressures every 8 h to minimize inadvertent drops in endotracheal tube cuff pressure was no better at preventing VAP, decreasing length-of-stay, or lowering mortality in a recent single center study compared to checking cuff pressures only at intubation, following frank tube migration, or detection of a cuff pressure leak [105]. A meta-analysis of three randomized trials of automated cuff pressure monitoring did report significantly lower VAP rates with automated cuff pressure systems, but the analysis was limited by small numbers, substantial heterogeneity, and limited evaluation of secondary outcomes [106].…”

Section: In Intubated Patients Suspected Of Having Vap Should Distalmentioning

confidence: 99%

Ventilator-associated pneumonia in adults: a narrative review

Papazian¹,

2020

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Ventilator-associated pneumonia (VAP) is one of the most frequent ICU-acquired infections. Reported incidences vary widely from 5 to 40% depending on the setting and diagnostic criteria. VAP is associated with prolonged duration of mechanical ventilation and ICU stay. The estimated attributable mortality of VAP is around 10%, with higher mortality rates in surgical ICU patients and in patients with mid-range severity scores at admission. Microbiological confirmation of infection is strongly encouraged. Which sampling method to use is still a matter of controversy. Emerging microbiological tools will likely modify our routine approach to diagnosing and treating VAP in the next future. Prevention of VAP is based on minimizing the exposure to mechanical ventilation and encouraging early liberation. Bundles that combine multiple prevention strategies may improve outcomes, but large randomized trials are needed to confirm this. Treatment should be limited to 7 days in the vast majority of the cases. Patients should be reassessed daily to confirm ongoing suspicion of disease, antibiotics should be narrowed as soon as antibiotic susceptibility results are available, and clinicians should consider stopping antibiotics if cultures are negative.

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Section: In Intubated Patients Suspected Of Having Vap Should Distalmentioning

confidence: 99%

Ventilator-associated pneumonia in adults: a narrative review

Papazian¹,

2020

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“…Although CPs are usually assessed immediately after intubation, or after the ETT has been repositioned, they can drop between 6 and 20 cm H 2 O between scheduled monitoring times [10,30]. This suggests that closely monitoring CETTs may prevent the adverse effects mentioned above.…”

Section: Discussionmentioning

confidence: 99%

“…This suggests that closely monitoring CETTs may prevent the adverse effects mentioned above. However further study is required to determine just how often CP monitoring should be done, as a recent study by Letvin et al [30] found that frequent CP monitoring was not associated with clinical outcome benefit compared with infrequent monitoring.…”

Section: Discussionmentioning

confidence: 99%

Endotracheal cuff pressures in the PICU: Incidence of underinflation and overinflation

et al. 2020

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Background: While uncuffed endotracheal tubes have been traditionally used in the pediatric intensive care unit (PICU) population, evidence suggests cuffed endotracheal tubes (ETTs) are also safe to use within this population. Nevertheless, risks related to the use of cuffed ETTs increase when guidelines for safe and appropriate use are not followed. The primary goal of this study was to measure the cuff pressure (CP) using a cuff pressure manometer in a group of intubated pediatric subjects and determine the rate of cuff underinflation (<20 cm H 2 0) or overinflation (>30 cm H 2 0). The secondary aim was to determine whether CP was associated to gender, age, ETT size, and PICU length of stay prior to CP measurement. Methods: This was a prospective observational study conducted in an urban PICU. Pediatric subjects intubated with cuffed ETTs from 1 April 2017 to 1 May 2017 were included in the study. ETT CPs were measured daily to determine degree of inflation and compared according to gender, age, ETT size, and number of days intubated prior to CP measurement. Descriptive data are expressed as means and standard deviations. A two-sample t test was used to compare groups according to age, gender, and number of days present. And significance was considered with a P < 0.05. Pearson chi test was used to evaluate correlation between CPs and size of the ETT, number of days intubated prior to CP measurement, gender, and age. Results: Twenty pediatric subjects admitted during the study period were included for analysis. Eleven cuff measurements were found to be within normal limits, while 9 cuff measurements were found to be underinflated. No cases of overinflation were found. There were no significant associations between CP and size of the ETT (r = -0.08), number of days intubated prior to CP measurement (r = 0.19), gender (r = 0.09), and age (r = 0.12). Conclusions:Our study suggests that endotracheal cuff underinflation occurs often in the PICU population. Strategies to ensure appropriate ETT CPs are maintained are essential in the intubated pediatric population. Additional studies are necessary to develop interventions and training focused on the use of a cuff pressure manometer to measure CPs in the PICU by respiratory therapists and ensure consistent measurement using inter rater evaluation processes are needed.

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“…The cuff pressure of ETTs inserted into a patient's trachea may rise and, more frequently, drop under certain circumstances or just over time . Therefore, it is routine nursing care to periodically check and adjust the cuff pressure in mechanically ventilated patients, even if there is recent evidence that frequent cuff pressure monitoring may not be associated with clinical outcome benefit compared to less frequent cuff pressure monitoring …”

Section: Discussionmentioning

confidence: 99%

“…Whether continuous cuff pressure regulators are superior to manual cuff pressure manometers to prevent VAP or whether the reliable provision of continuous airway pressure is more efficient to prevent leakage past the tracheal tube, has to be confirmed by further studies. A very simple method to avoid frequent cuff pressure drops resulting from connection of a manual cuff pressure manometer is to monitor the cuff pressure less frequent, which was recently shown to result in similar clinical outcome in adults, but raising some questions …”

Section: Discussionmentioning

confidence: 99%