CHEST Guidelines-Response_chest

Response_chest_23

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The article discusses the effectiveness of a device designed for the continuous regulation of tracheal cuff pressure in mechanically ventilated trauma patients to reduce ventilator-associated pneumonia (VAP). The study by Marjanovic et al. highlights that the device did not significantly enhance outcomes compared to standard care, such as manual intermittent tracheal cuff pressure adjustments. This lack of positive effect is surprising as aspiration of oropharyngeal content, expected to be mitigated by effective cuff pressure regulation, is a known contributor to VAP. The article explores potential reasons for the device's ineffectiveness, including its frequent disconnection during patient care activities like intrahospital transport, which might lead to aspiration.<br /><br />The letter by Lakhal et al. suggests that the study's outcomes might not generalize to less cumbersome devices that aren't frequently disconnected. It points out the device's bulkiness and short connection lines as potential flaws, which led to frequent disconnections during crucial times.<br /><br />Marjanovic et al.'s response acknowledges the frequent disconnections but argues they likely don't fully account for the lack of benefits. They note that device disconnections constituted only 1.4% of total ventilation time, mostly during patient transfers, a stage already known for high aspiration risk. They stress the need for more transportable devices and suggest that if future findings confirm their results, there might be merit in reevaluating the current understanding of VAP pathophysiology.<br /><br />The discussion concludes with a note that while continuous tracheal cuff pressure monitoring has potential benefits, its efficacy needs more robust clinical validation before it can be widely recommended. The dialogue encourages ongoing exploration of new methods and understanding of VAP prevention.

Keywords

tracheal cuff pressure

ventilator-associated pneumonia

mechanically ventilated patients

device effectiveness

Marjanovic et al.

Lakhal et al.

aspiration risk

patient care activities

VAP prevention

clinical validation