Document Detail


Continuous Control of Tracheal Cuff Pressure and Microaspiration of Gastric Contents in Critically Ill Patients.
MedLine Citation:
PMID:  21836137     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
RATIONALE: underinflation of tracheal cuff frequently occurs in critically ill patients, and represents a risk factor for microaspiration of contaminated oropharyngeal secretions and gastric contents that plays a major role in the pathogenesis of ventilator-associated pneumonia (VAP). OBJECTIVE: to determine the impact of continuous control of tracheal cuff pressure (Pcuff) on microaspiration of gastric contents. METHODS: prospective randomized controlled trial performed in a single medical ICU. A total of 122 patients expected to receive mechanical ventilation for at least 48h through a tracheal tube were randomized to receive continuous control of Pcuff using a pneumatic device (intervention group, n=61) or routine care of Pcuff (control group, n=61). MEASUREMENTS AND MAIN RESULTS: primary outcome was microaspiration of gastric contents as defined by the presence of pepsin at significant level in tracheal secretions collected during the 48h following randomization. Secondary outcomes included incidence of VAP, tracheobronchial bacterial concentration, and tracheal ischemic lesions. The pneumatic device was efficient in controlling Pcuff. Pepsin was measured in 1205 tracheal aspirates. Percentage of patients with abundant microaspiration (18% vs 46%, p=0.002, OR[95% CI] 0.25[0.11-0.59]), bacterial concentration in tracheal aspirates (mean±SD 1.6±2.4 vs 3.1±3.7 log10 cfu/mL, p=0.014) and VAP rate (9.8% vs 26.2%, p=0.032, 0.30[0.11-0.84]) were significantly lower in intervention group compared with control group. However, no significant difference was found in tracheal ischemia score between the two groups. CONCLUSIONS: continuous control of Pcuff is associated with significantly decreased microaspiration of gastric contents in critically ill patients. Clincal trial registration information available at www.clinicaltrials.gov, i.d. = NCT01082666.
Authors:
Saad Nseir; Farid Zerimech; Clément Fournier; Rémy Lubret; Philippe Ramon; Alain Durocher; Malika Balduyck
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-8-11
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  -     ISSN:  1535-4970     ISO Abbreviation:  -     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-8-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
ICU, Calmette hospital, CHRU, Lille, France.
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