CHEST Guidelines-Continuous-Pneumatic-Regulation-of-Tracheal-Cuff-P

Continuous-Pneumatic-Regulation-of-Tracheal-Cuff-P

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The AGATE study was a multicenter randomized controlled trial conducted across 13 French ICUs to evaluate whether continuous pneumatic regulation of tracheal cuff pressure was more effective than manual checks for preventing ventilator-associated pneumonia (VAP) in severely traumatized, mechanically ventilated patients. VAP is a frequent healthcare-associated infection in severely ill patients, largely caused by the aspiration of contaminated oropharyngeal secretions around the tracheal tube cuff. This study aimed to determine if continuous regulation using a pneumatic device could reduce the incidence of VAP compared to traditional manual regulation using a portable manometer checked three times daily.<br /><br />Between 2015 and 2018, 434 patients were enrolled, with half assigned to a group receiving continuous pneumatic regulation and the other half to a control group practicing routine manual regulation. The primary outcome measured was the proportion of patients developing VAP within 28 days post-intubation. The results indicated that 33.8% of patients in the intervention group developed VAP compared to 29.4% in the control group. Statistically, there was no significant difference in VAP incidence between the two methods (adjusted subdistribution hazard ratio, 0.96; 95% CI, 0.76-1.20; P = .71).<br /><br />These findings suggest that continuous pneumatic regulation does not reduce VAP incidence more effectively than manual checks in severe trauma patients. The study concludes that while current continuous cuff pressure regulation devices may not provide significant benefits over manual regulation in preventing VAP, potential benefits or adjustments could exist in broader or different patient populations. Further research addressing the limitations of this study is necessary to explore the possible advantages of continuous regulation devices in preventing VAP.

Keywords

AGATE study

multicenter trial

tracheal cuff pressure

ventilator-associated pneumonia

mechanically ventilated patients

pneumatic regulation

manual regulation

healthcare-associated infection

severely traumatized patients

continuous regulation devices