CHEST Guidelines-Regulation-of-Tracheal-Cuff-Pressure

Regulation-of-Tracheal-Cuff-Pressure_chest

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The letter to the editor discusses a study conducted by Marjanovic et al. that evaluates the effectiveness of a device for continuously regulating tracheal cuff pressure in mechanically ventilated trauma patients. This was the first multicenter randomized controlled study of its kind. The study found no significant benefit of using the device over standard care, which involves manual adjustment of the cuff pressure. The primary outcome, the incidence of ventilator-associated pneumonia (VAP), was not affected by the device, contrary to expectations since controlling tracheal cuff pressure is believed to limit aspiration of oropharyngeal content, a major contributor to VAP.<br /><br />The letter suggests several reasons for the lack of positive results. The tested device, Nosten, was bulky, with a short connecting line, leading to frequent disconnections, particularly during crucial moments such as nursing care or patient transport. This could be when the device was most needed to prevent aspiration.<br /><br />Moreover, a secondary analysis from a previous single-center study showed the device was efficient at controlling tracheal cuff pressure; however, frequent disconnections in the Marjanovic et al. study may have led to misuse and pressure underinflation, negating potential benefits. <br /><br />The authors of the letter hypothesize that the findings may not apply to more streamlined devices that are less likely to be disconnected. They suggest that if future studies confirm that intermittent and continuous regulation of cuff pressure are equally effective, it could challenge the current understanding that aspiration is the main cause of VAP and suggest exploring other pathways.<br /><br />The document also includes a brief response from Marjanovic et al., acknowledging the feedback and noting the frequent device disconnections recorded during their study.

Keywords

tracheal cuff pressure

mechanically ventilated

trauma patients

ventilator-associated pneumonia

Nosten device

multicenter randomized controlled study

aspiration

device disconnections

cuff pressure regulation

Marjanovic et al.