CHEST Guidelines-Continuous-Control-of-Tracheal-Cuff-Pressure-and-V

Continuous-Control-of-Tracheal-Cuff-Pressure-and-V

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Ventilator-associated pneumonia (VAP) is a significant concern in patients undergoing prolonged mechanical ventilation, leading to increased morbidity and extended hospital stays. A major cause of VAP is microaspiration of oropharyngeal and gastric secretions due to underinflated tracheal cuffs. Continuous control of tracheal cuff pressure has emerged as a potential preventive measure to reduce VAP incidence. Studies have demonstrated varying levels of effectiveness for continuous cuff pressure control compared to manual control with a manometer.<br /><br />Research by Nseir and colleagues showed that continuous cuff pressure regulation could reduce microaspiration and VAP incidence. Similarly, Lorente et al. reported decreased VAP in patients with continuous control of cuff pressure. However, Valencia et al. observed no significant difference between continuous and manual cuff pressure control.<br /><br />The AGATE study, a large multicenter randomized controlled trial involving 434 trauma patients, aimed to evaluate the impact of continuous pneumatic regulation of tracheal cuff pressure on VAP incidence. The study found no significant difference in VAP incidence between the intervention and control groups. The absence of marked effects could be attributed to factors like data collection limitations on cuff pressure, device misuse, and other confounding factors such as antimicrobial use and patient positioning.<br /><br />Future research should address these limitations to better assess the role of continuous cuff pressure control in VAP prevention. While promising, continuous control of cuff pressure is not yet recommended as a routine practice until more conclusive evidence from comprehensive studies is available.

Keywords

ventilator-associated pneumonia

VAP

mechanical ventilation

tracheal cuff pressure

microaspiration

continuous pressure control

Nseir study

Lorente study

AGATE trial

VAP prevention