Intermittent versus continuous control of tracheal cuff pressure in patients undergoing mechanical ventilation: A systematic review and meta‐analysis

Abstract

Aims and Objectives To evaluate the effects and safety of intermittent versus continuous control of cuff pressure in patients with mechanical ventilation. Background Tracheal cuff pressure management is vital to the prognosis of patients with mechanical ventilation. Design A meta‐analysis. Methods This meta‐analysis was conducted and reported according to the PRISMA checklist. We searched Pubmed, Embase, The Cochrane Library, BMJ Best Practice, Web of Science, ProQuest Dissertations, as well as the Chinese Biomedical Literature Database, Wanfang, and China national knowledge infrastructure databases up to 5 August 2022 for randomised controlled trials (RCTs) on the intermittent versus continuous control of cuff pressure. Review Manager 5.3 software was used for relevant data analysis. Results A total of 18 RCTs involving 1998 patients with mechanical ventilation were included. The synthesised outcomes indicated that continuous control of cuff pressure is beneficial to reduce the incidence of ventilator‐associated pneumonia (VAP) [RR = 0.41, 95%CI (0.35, 0.49)], aspiration [RR = 0.36, 95%CI (0.21, 0.63)], duration of mechanical ventilation [MD = ‐3.23, 95%CI (−4.66, −1.79)], length of ICU stay [MD = ‐4.12, 95%CI (−5.40, −2.83)], and increase the volume of subglottic drainage [MD = 18.54, 95%CI (16.50, 20.58)]. There was no significant difference in the mortality between two groups [RR = 1.01, 95%CI (0.84, 1.21)]. Egger regression analyses showed that there were no obvious publication biases in the synthesised results (all p > .05). Conclusions Existing evidence shows that compared with intermittent monitoring of cuff pressure, continuous monitoring of cuff pressure can reduce the occurrence of aspiration and VAP, shorten the patient's duration of mechanical ventilation and length of ICU stay. Relevance to Clinical Practice Continuous monitoring of cuff pressure is more beneficial and should be promoted in clinical nursing care of patients undergoing mechanical ventilation.

Construction and Application of a Training Program for ICU Nurses to Manage Artificial Airway Gasbags to Prevent Ventilator-Associated Pneumonia

“…Effective artificial airway gasbag management can reduce the incidence of VAP, shorten the patient's time of mechanical ventilation, and length of ICU stay, improve patient prognosis, and accelerate patient recovery. [4][5][6] It is critical for reducing complications related to artificial airways. 7 ICU nurses are indispensable as practitioners of artificial airway gasbag management.…”

Comment on intermittent versus continuous control of tracheal cuff pressure in patients undergoing mechanical ventilation

“…cuff pressure control reduced risks of ventilator-associated pneumonia (VAP) and aspiration as well as duration of mechanical ventilation, and ICU length of stay compared to intermittent control (Chen et al, 2023). Their finding highlighted that control of tracheal cuff pressure is vital for preventing complications such as VAP, which can significantly impact patient outcomes.…”

“…Their results provide valuable insights for nursing and medical staff to guide the implementation of best practices in mechanical ventilation. We congratulate Chen et al (Chen et al, 2023) in a well-conducted review summarizing the latest evidence on this clinically important topic. However, a few limitations should be addressed.…”

“…First, although the authors (Chen et al, 2023) acknowledge that most of the included RCTs were from China and France, possibly introducing regional and population biases, further analysis was not performed. A subgroup analysis based on country offers more nuanced insights, potentially providing information regarding the generalizability of the findings.…”

“…When the accumulated Z-curve surpasses the trial sequential monitoring boundary or achieves the necessary information size, the evidence is considered robust and reliable (De Cassai et al, 2021). Because TSA was not performed in the original meta-analysis (Chen et al, 2023), we conducted TSA using raw data from the meta-analysis (Chen et al, 2023) on VAP incidence. Comprehensive Meta-Analysis software, Version 4, provided by Biostat (Englewood, NJ, USA), was used for the analysis as previously reported (Hung et al, 2021(Hung et al, , 2023.…”