Polyurethane cuffed endotracheal tubes to prevent early postoperative pneumonia after cardiac surgery: A pilot study

Poelaert, Jan; Depuydt, Pieter; Wolf, A; Velde, Stijn Van de; Herck, Ingrid; Blot, Stijn

doi:10.1016/j.jtcvs.2007.08.052

Cited by 129 publications

(99 citation statements)

References 33 publications

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“…Cox regression analysis showed that polyvinyl cuffed tubes were a risk factor for global VAP (hazard ratio (HR) 3.3; = 0.001), early onset VAP (HR 3.3, = 0.02), and late onset VAP (HR 3.5; = 0.01). In addition, a prospective, single-blinded, randomized pilot study revealed that the PU-cuffed ETTs reduced the frequency of early postoperative pneumonia in cardiac surgical patients [18]. Our study, however, demonstrates a significant reduction of VAP incidence on a larger scale with a PU-cuffed ETT.…”

Section: Discussioncontrasting

confidence: 56%

Impact of a Low-Pressure Polyurethane Adult Endotracheal Tube on the Incidence of Ventilator-Associated Pneumonia: A before and after Concurrence Study

et al. 2013

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Background. Ventilator-associated pneumonia (VAP) is a leading cause of morbidity and mortality in intensive care unit (ICU) patients, encompassing up to 15% of all hospital acquired infections. Our hospital implemented a facility-wide conversion from a low-volume high-pressure polyvinyl cuffed endotracheal tube (PV-cuffed ETT) to a high-volume low-pressure (HVLP) polyurethane-cuffed endotracheal tube (PU-cuffed ETT) in an effort to reduce the incidence of VAP. Methods. We completed an IRB approved, retrospective chart review comparing the number of episodes of VAP 12 months preceding and following the introduction of a new ETT. A diagnosis of VAP was made based upon the guidelines of our institution, consistent with the Center of Disease Control and Prevention definition. Results. The number of patients developing VAP the year after the ETT conversion reduced to 32 (16.3%) from 68 (24.7%) the year before the conversion ( = 0.028). The rate of VAP was reduced by 56% per ventilator day after the implementation of the PU-cuffed ETT ( < 0.001). No significant differences were observed in length of hospital stay, length of mechanical ventilation, or mortality before or after the conversion. Conclusions. We found that HVLP PU-cuffed ETTs were associated with a statistically significant reduction of VAP in the adult ICUs.

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Section: Discussioncontrasting

confidence: 56%

Impact of a Low-Pressure Polyurethane Adult Endotracheal Tube on the Incidence of Ventilator-Associated Pneumonia: A before and after Concurrence Study

et al. 2013

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“…70,71,75,[85][86][87] Significantly reduced microaspiration has been reproduced in clinical trials, 75,78 coinciding with significant reductions in VAP (26 -45% relative decrease). [88][89][90] However, others have not been able to demonstrate the superiority of polyurethane-cuffed ETTs in reducing microaspiration. 91 Use of specialized ETTs may be of particular benefit in trauma and acute brain injury patients.…”

Section: Modifiable Risk Factors For Ventilator-associated Pneumonia mentioning

confidence: 99%

The Vexing Problem of Ventilator-Associated Pneumonia: Observations on Pathophysiology, Public Policy, and Clinical Science

Kallet

2015

Respir Care

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SummaryVentilator-associated pneumonia (VAP) is an acquired infection related primarily to the consequences of prolonged endotracheal intubation. It is considered the most important infectious challenge in the critical care setting. Preventable complications of hospital care are considered an important source of wasted health-care costs believed to consume up to 47% of annual expenditures in the United States. Whether VAP is preventable has become a highly contentious debate since public reporting commenced a decade ago. This selective review focuses on specific aspects of this debate, including the inherent vagaries in the diagnosis of VAP and the marked disparities between VAP rates based on clinical diagnosis versus surveillance data. Also discussed is how this debate has impacted public policy, leading to the new paradigm of ventilator-associated events. The limited ability of artificial airways to prevent microaspiration and biofilm build-up, as well as non-modifiable conditions increasing the risk of VAP, is described in detail. In addition, the origins of the mistaken but widely embraced notion that zero VAP is a realistic achievement are examined.

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“…Based on literatures, advanced age, obesity, cigarette smokers, American Society of Anesthesiologist (ASA) physical status of>II, chronic obstructive pulmonary disease (COPD), low albumin level, upper abdominal and thoracic surgery, prolonged surgical and anesthesia time [10,11], general anesthesia with long acting muscle relaxant [12] and type of endotracheal tube [13] are the identified risk factors for postoperative pulmonary complications.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Pulmonary Complications and Associated Factors among Surgical Patients

Denu¹,

Yasin²,

Melekie³

et al. 2015

J Anesth Clin Res

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Polyurethane cuffed endotracheal tubes to prevent early postoperative pneumonia after cardiac surgery: A pilot study

Abstract: Polyurethane cuffed endotracheal tubes can reduce the frequency of early postoperative pneumonia in cardiac surgical patients.

Cited by 129 publications

References 33 publications

Impact of a Low-Pressure Polyurethane Adult Endotracheal Tube on the Incidence of Ventilator-Associated Pneumonia: A before and after Concurrence Study

Impact of a Low-Pressure Polyurethane Adult Endotracheal Tube on the Incidence of Ventilator-Associated Pneumonia: A before and after Concurrence Study

The Vexing Problem of Ventilator-Associated Pneumonia: Observations on Pathophysiology, Public Policy, and Clinical Science

Postoperative Pulmonary Complications and Associated Factors among Surgical Patients

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