Efficiency of a mechanical device in controlling tracheal cuff pressure in intubated critically ill patients: a randomized controlled study
Background: Cuff pressure (P-cuff) 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 (R)) in the continuous control of Pcuff in patients intubated w...
| Autores: | , , , , , , |
|---|---|
| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2015 |
| País: | España |
| Institución: | Institut d'Investigació i Innovació Parc Taulí (I3PT) |
| Repositorio: | r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí |
| OAI Identifier: | oai:i3pt.fundanetsuite.com:p4629 |
| Acceso en línea: | https://i3pt.portalinvestigacion.com/publicaciones/4629 |
| Access Level: | acceso abierto |
| Palabra clave: | Cuff pressure Control Tracheal ischemia Microaspiration Mechanical ventilation |
| Sumario: | Background: Cuff pressure (P-cuff) 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 (R)) 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 (R) 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 cmH(2)O during the two periods. Results: The percentage of time spent with P-cuff 20-30 cmH(2)O (median (IQR) 34 % (17-57) versus 50 % (35-64), p = 0.184) and the percentage of time spent with P-cuff <20 cmH(2)O (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 P-cuff >30 cmH(2)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 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 (R) did not demonstrate a better control of P-cuff between 20 and 30 cmH(2)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. |
|---|