Prevention of ventilator-associated pneumonia

Lau, Arthur Chun‐Wing; So, Hang Mui; Tang, Shengpu; Yeung, Alwin; Lam, Sin‐Man; Yan, Wing Wa

doi:10.12809/hkmj144367

Cited by 19 publications

(17 citation statements)

References 33 publications

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“…This has been associated with tracheal injuries including mucosal inflammation, mucosal ischaemia, tracheal ulceration, stenosis, tracheo-oesophageal fistula, tracheomalacia and tracheal rupture [3][4][5][6][7][8][9][10] . Conversely, under-inflation of the cuff is associated with inadequate ventilation and microaspiration 9,[11][12][13] , which may result in ventilator-acquired complications including pneumonia 14 .…”

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confidence: 99%

Does Objective Measurement of Tracheal Tube Cuff Pressures Minimise Adverse Effects and Maintain Accurate Cuff Pressures? A Systematic Review and Meta-Analysis

Hockey

Zundert

Paratz

2016

Anaesth Intensive Care

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Correct inflation pressures of the tracheal cuff are recommended to ensure adequate ventilation and prevent aspiration and adverse events. However there are conflicting views on which measurement to employ. The aim of this review was to examine whether adjustment of cuff pressure guided by objective measurement, compared with subjective measurement or observation of the pressure value alone, was able to prevent patient-related adverse effects and maintain accurate cuff pressures. A search of PubMed, Web of Science, Embase, CINAHL and ScienceDirect was conducted using keywords 'cuff pressure' and 'measure*' and related synonyms. Included studies were randomised or pseudo-randomised controlled trials investigating mechanically ventilated patients both in the intensive care unit and during surgery. Outcomes included adverse effects and the comparison of pressure measurements. Pooled analyses were performed to calculate risk ratios, effect sizes and 95% confidence intervals. Meta-analysis found preliminary evidence that adjustment of cuff pressure guided by objective measurement as compared with subjective measurement or observation of the pressure value alone, has benefit in preventing adverse effects. These included cough at two hours (odds ratio [OR] 0.42, confidence interval [CI] 0.23 to 0.79, P=0.007), hoarseness at 24 hours (OR 0.49, CI 0.31 to 0.76, P <0.002), sore throat (OR 0.73, CI 0.54 to 0.97, P <0.03), lesions of the trachea and incidences of silent aspiration (P=0.001), as well as maintaining accurate cuff pressures (Hedges' g 1.61, CI 2.69 to 0.53, P=0.003). Subjective measurement to guide adjustment or observation of the pressure value alone may lead to patient-related adverse effects and inaccuracies. It is recommended that an objective form of measurement be used.

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confidence: 99%

Does Objective Measurement of Tracheal Tube Cuff Pressures Minimise Adverse Effects and Maintain Accurate Cuff Pressures? A Systematic Review and Meta-Analysis

Hockey

Zundert

Paratz

2016

Anaesth Intensive Care

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“…When a syringe was used, accompanied by assessment of in ation using the palpation method, over in ation occurred in 89% of cases. In other researches into proper endotracheal tube cuff in ation, authors indicate that too low pressure in the cuff seal can cause complications such as tube displacement or inhalation of stomach contents into the airways [9][10][11]. Our research showed that insu cient cuff in ation occurred in 4.63% of cases, and took place only when a syringe was used.…”

Section: Discussionmentioning

confidence: 53%

“…It has been proven that during palpation assessment, the cuff seal is overin ated, even to as high as 100 cm H2O [4]. Application of incorrect pressure in the endotracheal tube cuff seal can be extremely worrying as it may cause numerous complications [6][7][8][9][10][11]. In pre-hospital paramedic treatment, intubation is often used as the chosen method for clearing the airways.…”

Section: Introductionmentioning

confidence: 99%

Endotracheal tube cuff pressure – how fast paramedics can learn the optimal inflation? - comparison of different methods

Ilczak

Ćwiertnia

Białoń

et al. 2020

Preprint

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Background Tracheal intubation is the optimal method for opening up the airways. Performed correctly, it prevents stomach contents from entering the respiratory tract, and allows asynchronous CPR to be conducted during sudden cardiac arrest. An important element of correct intubation is proper inflation of the endotracheal tube cuff. Research has shown that when medical personnel use the palpation technique, the cuff is usually inflated incorrectly. This can result in numerous health complications for the patient. Methods This research was conducted in 2020 on a group of paramedics participating in the 15th International Winter Championship of Medical Rescuers in Bielsko-Biała. The aim of the research was to assess two methods of inflating the endotracheal tube cuff. Method A involved inflating the cuff using a syringe and assessing the pressure in the control cuff using the palpation technique. Method B involved inflating the cuff using a manometer. During the inflation, both the cuff inflation pressure and the time required to complete the procedure were recorded. Analysis was also conducted on whether completion of certified ALS and ACLS training had any influence on the effectiveness of the inflation procedure. Results The research showed that paramedics using method B significantly more often inflated the endotracheal tube cuff to the correct pressure than those using method A. However, when method B was used, the procedure took longer to conduct. The study also showed that completion of certified ALS or ACLS training did not have a significant influence on proper inflation of the cuff. Those who had completed certified training courses took significantly longer to inflate the endotracheal tube cuff when using method A. Conclusions Inflation of the endotracheal tube cuff by use of a syringe, followed by the palpation technique for assessing the inflation of the cuff balloon is ineffective. Paramedic teams should be equipped with manometers to be used for inflating the endotracheal tube cuff.

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“…[3][4] Other VAP prevention strategies have also been acknowledged in the literature, including simple and cost-effective measures. [5] Evidently, one of the recognized cost-effective quality improvement strategies in low-resource intensive care units (ICUs) is the educational intervention. [6] Educational programs that include well-planned evidence-based practice elements to improve both clinician learning and patient outcomes have also become a common practice in multidisciplinary ICUs.…”

Section: Introductionmentioning

confidence: 99%

Association of Educational Interventions with Clinician Learning and Ventilator-Associated Pneumonia Patient Outcomes: A Protocol for Systematic Review and Meta-Analysis

Gutiérrez¹,

Dueño²,

Sonido³

et al. 2020

jmust

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Recent studies have shown that educational interventions for ventilator-associated pneumonia (VAP) prevention may result in positive outcomes in intensive care units. However, other studies investigating this kind of intervention have produced inconsistent results. Thus this paper reports a protocol for systematic review and planned meta-analysis to investigate the association of instituted VAP educational interventions with clinician learning and patient outcomes. In this review, the authors will identify relevant citations from electronic databases, reference lists, and other sources; screen articles against predetermined eligibility criteria; appraise each study using the Cochrane Collaboration's risk of bias assessment

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Prevention of ventilator-associated pneumonia

Cited by 19 publications

References 33 publications

Does Objective Measurement of Tracheal Tube Cuff Pressures Minimise Adverse Effects and Maintain Accurate Cuff Pressures? A Systematic Review and Meta-Analysis

Does Objective Measurement of Tracheal Tube Cuff Pressures Minimise Adverse Effects and Maintain Accurate Cuff Pressures? A Systematic Review and Meta-Analysis

Endotracheal tube cuff pressure – how fast paramedics can learn the optimal inflation? - comparison of different methods

Association of Educational Interventions with Clinician Learning and Ventilator-Associated Pneumonia Patient Outcomes: A Protocol for Systematic Review and Meta-Analysis

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