Under- or overpressure: an audit of endotracheal cuff pressure monitoring at the tertiary care center
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background Mechanical ventilation is a lifesaving intervention for critically ill patients but can produce the major complication of ventilator-associated pneumonia (VAP). Inappropriately inflated endotracheal tubes cause potential harm due to high or low pressure; this can be prevented through monitoring protocols. Methods A cross-sectional study of 348 cuff pressure readings was performed with intubated and mechanically ventilated patients to evaluate the exact proportion of patients in intensive care units (ICUs) where the cuff pressure is optimal and to identify the ICUs where device-based monitoring is available to produce a lower proportion of sub-optimal cuff pressure cases. Every three days, cuff pressure was assessed with a handheld cuff pressure manometer. The corresponding VAP rates of those ICUs were obtained from the hospital infection control department. Results Cuff pressure of 40.2% was the lower cutoff for the high category, that of optimal was 35.3%, and the highest cutoff of sub-optimal was 24.4%. This study also showed ICUs that had cuff pressure monitoring devices and protocols. Active measurement protocols had a higher proportion of optimal cuff pressure (58.5%) and a lower proportion of sub-optimal and high cuff pressure (19.5% and 22.0%) compared to ICUs with no device-based monitoring protocols. Furthermore, the VAP rate of ICUs exhibited a weak positive correlation with sub-optimal cuff pressure. Conclusions Device-based cuff pressure monitoring is essential in maintaining adequate cuff pressure but often is inadequate, resulting in high readings. Therefore, this study suggests that device-based cuff pressure monitoring be practiced.
Abstract
Background Mechanical ventilation is a lifesaving intervention for critically ill patients but can produce the major complication of ventilator-associated pneumonia (VAP). Inappropriately inflated endotracheal tubes cause potential harm due to high or low pressure; this can be prevented through monitoring protocols. Methods A cross-sectional study of 348 cuff pressure readings was performed with intubated and mechanically ventilated patients to evaluate the exact proportion of patients in intensive care units (ICUs) where the cuff pressure is optimal and to identify the ICUs where device-based monitoring is available to produce a lower proportion of sub-optimal cuff pressure cases. Every three days, cuff pressure was assessed with a handheld cuff pressure manometer. The corresponding VAP rates of those ICUs were obtained from the hospital infection control department. Results Cuff pressure of 40.2% was the lower cutoff for the high category, that of optimal was 35.3%, and the highest cutoff of sub-optimal was 24.4%. This study also showed ICUs that had cuff pressure monitoring devices and protocols. Active measurement protocols had a higher proportion of optimal cuff pressure (58.5%) and a lower proportion of sub-optimal and high cuff pressure (19.5% and 22.0%) compared to ICUs with no device-based monitoring protocols. Furthermore, the VAP rate of ICUs exhibited a weak positive correlation with sub-optimal cuff pressure. Conclusions Device-based cuff pressure monitoring is essential in maintaining adequate cuff pressure but often is inadequate, resulting in high readings. Therefore, this study suggests that device-based cuff pressure monitoring be practiced.
참고문헌 (19)
- Magill SS, "Changes in prevalence of health care-associated infections in U.S. hospitals", N Engl J Med, 379, pp.1732~1744 (2018)
- Haas CF, "Endotracheal tubes : old and new", Respir Care, 59, pp.933~952 (2014)
- Letvin A, "Frequent versus infrequent monitoring of endotracheal tube cuff pressures", Respir Care, 63, pp.495~501 (2018)
- Akdogan O, "Assessment of the effectiveness of a ventilator associated pneumonia prevention bundle that contains endotracheal tube with subglottic drainage and cuff pressure monitorization", Braz J Infect Dis, 21, pp.276~281 (2017)
- Hamilton VA, "The role of the endotracheal tube cuff in microaspiration", Heart Lung, 41, pp.167~172 (2012)
- Rello J, "Pneumonia in intubated patients : role of respiratory airway care", Am J Respir Crit Care Med, 154, pp.111~115 (1996)
- Álvarez-Lerma F, ""The multimodal approach for ventilator-associated pneumonia prevention"-requirements for nationwide implementation", Ann Transl Med, 6, pp.420~ (2018)
- Fu Y, "Analysis on risk factors of endotracheal cuff under inflation in mechanically ventilated patients", Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 26, pp.870~874 (2014)
- Nseir S, "Variations in endotracheal cuff pressure in intubated critically ill patients: prevalence and risk factors", Eur J Anaesthesiol, 26, pp.229~234 (2009)
- Nseir S, "Microaspiration in intubated critically ill patients : diagnosis and prevention", Infect Disord Drug Targets, 11, pp.413~423 (2011)
- Jaillette E, "Efficiency of a pneumatic device in controlling cuff pressure of polyurethane-cuffed tracheal tubes : a randomized controlled study", BMC Anesthesiol, 13, pp.50~ (2013)
- Sengupta P, "Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure", BMC Anesthesiol, 4, pp.8~ (2004)
- Ranjan N, "Ventilator-associated pneumonia in a tertiary care intensive care unit: analysis of incidence, risk factors and mortality", Indian J Crit Care Med, 18, pp.200~204 (2014)
- Mukhopadhyay C, "Role of mechanical ventilation & development of multidrug resistant organisms in hospital acquired pneumonia", Indian J Med Res, 118, pp.229~235 (2003)
- Stevens GJ, "Intraoperative endotracheal cuff pressure study: how education and availability of manometers help guide safer pressures", Mil Med, 183, pp.e416~e419 (2018)
- Rouzé A, "Airway devices in ventilator-associated pneumonia pathogenesis and prevention", Clin Chest Med, 39, pp.775~783 (2018)
- Jaillette E, "Impact of tapered-cuff tracheal tube on microaspiration of gastric contents in intubated critically ill patients : a multicenter cluster-randomized cross-over controlled trial", Intensive Care Med, 43, pp.1562~1571 (2017)
- Alzahrani AR, "Prevalence and predictors of out-of-range cuff pressure of endotracheal and tracheostomy tubes : a prospective cohort study in mechanically ventilated patients", BMC Anesthesiol, 15, pp.147~ (2015)
- Huang WM, "Tapered cuff versus conventional cuff for ventilator-associated pneumonia in ventilated patients : a meta-analysis of randomized controlled trials", Can Respir J, 2019, pp.7876417~ (2019)