Tracheal Cuff Management as Part of a Lung-Protective Strategy

Richard, Jean-Christophe M.; Mercat, Alain

doi:10.4187/respcare.03745

Cited by 2 publications

(3 citation statements)

References 14 publications

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“…For this reason, strategies as lung-protective ventilation have been adopted to avoid ventilator-induced lung injury [ 31 ] . Recently, authors have been reported some indirect adverse events secondary to mechanical ventilation, including tracheal injury [ 32 ] . For them, lung-protective mechanical ventilation would not be limited to mechanical ventilator adjustment, but also associated with intubation/extubation complications [ 32 ] .…”

Section: Introductionmentioning

confidence: 99%

“…Recently, authors have been reported some indirect adverse events secondary to mechanical ventilation, including tracheal injury [ 32 ] . For them, lung-protective mechanical ventilation would not be limited to mechanical ventilator adjustment, but also associated with intubation/extubation complications [ 32 ] . In these circumstances, cuff pressure management plays an important role to prevent complications: excessive cuff inflation could cause ischemic damage to tracheal mucosa; insufficient cuff inflation could promote subglottic secretion aspiration leading to pneumonia, also air escape around the cuff could negatively impact in prescribed tidal volume [ 33 ] .…”

Section: Introductionmentioning

confidence: 99%

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Cardiovascular involvement in COVID-19: not to be missed

Rocco

Gomes

Viceconte

et al. 2020

Braz J Cardiovasc Surg

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In December 2019, a striking appearance of new cases of viral pneumonia in Wuhan led to the detection of a novel coronavirus (SARS-CoV2). By analyzing patients with severe manifestations, it became apparent that 20 to 35% of patients who died had preexisting cardiovascular disease. This finding warrants the important need to discuss the influence of SARS-CoV2 infection on the cardiovascular system and hemodynamics in the context of clinical management, particularly during mechanical ventilation. The SARS-CoV2 enters human cells through the spike protein binding to angiotensin-converting enzyme 2 (ACE2), which is important to cardiovascular modulation and endothelial signaling. As ACE2 is highly expressed in lung tissue, patients have been progressing to acute respiratory injury at an alarming frequency during the Coronavirus Disease (COVID-19) pandemic. Moreover, COVID-19 leads to high D-dimer levels and prothrombin time, which indicates a substantial coagulation disorder. It seems that an overwhelming inflammatory and thrombogenic condition is responsible for a mismatching of ventilation and perfusion, with a somewhat near-normal static lung compliance, which describes two types of pulmonary conditions. As such, positive pressure during invasive mechanical ventilation (IMV) must be applied with caution. The authors of this review appeal to the necessity of paying closer attention to assess microhemodynamic repercussion, by monitoring central venous oxygen saturation during strategies of IMV. It is well known that a severe respiratory infection and a scattered inflammatory process can cause non-ischemic myocardial injury, including progression to myocarditis. Early strategies that guide clinical decisions can be lifesaving and prevent extended myocardial damage. Moreover, cardiopulmonary failure refractory to standard treatment may necessitate the use of extreme therapeutic strategies, such as extracorporeal membrane oxygenation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cardiovascular involvement in COVID-19: not to be missed

Rocco

Gomes

Viceconte

et al. 2020

Braz J Cardiovasc Surg

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“…Therefore, it is dependent on respiratory flow and airway pressure that may widely vary in critically ill patients. In addition, the key principle is probably an equilibrium between airway pressure and P cuff , which means that the time constant of the system might play a role in the higher P cuff [ 29 , 30 ]. Further, the exact P cuff target, using the mechanical device, could not be precisely determined or modified.…”

Section: Discussionmentioning

confidence: 99%

Efficiency of a mechanical device in controlling tracheal cuff pressure in intubated critically ill patients: a randomized controlled study

Nseir

Rodriguez

Saludes

et al. 2015

Ann. Intensive Care

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BackgroundCuff pressure (Pcuff) control is mandatory to avoid leakage of oral secretions passing the tracheal tube and tracheal ischemia. The aim of the present trial was to determine the efficacy of a mechanical device (PressureEasy®) in the continuous control of Pcuff in patients intubated with polyvinyl chloride (PVC)-cuffed tracheal tubes, compared with routine care using a manometer.MethodsThis is a prospective, randomized, controlled, cross-over study. All patients requiring intubation with a predicted duration of mechanical ventilation ≥48 h were eligible. Eighteen patients randomly received continuous control of Pcuff with PressureEasy® device for 24 h, followed by discontinuous control (every 4 h) with a manual manometer for 24 h, or vice versa. Pcuff and airway pressure were continuously recorded. Pcuff target was 25 cmH2O during the two periods.ResultsThe percentage of time spent with Pcuff 20–30 cmH2O (median (IQR) 34 % (17–57) versus 50 % (35–64), p = 0.184) and the percentage of time spent with Pcuff <20 cmH2O (23 % (5–63) versus 43 % (16–60), p = 0.5) were similar during continuous control of Pcuff and routine care, respectively. However, the percentage of time spent with Pcuff >30 cmH2O was significantly higher during continuous control compared with routine care of tracheal cuff (26 % (14–39) versus 7 % (1–18), p = 0.002). No significant difference was found in Pcuff (25 (18–28) versus 21 (18–26), p = 0.17), mean airway pressure (14 (10–17) versus 14 (11–16), p = 0.679), or coefficient of variation of Pcuff (19 % (11–26) versus 20 % (11–25), p = 0.679) during continuous control compared with routine care of tracheal cuff, respectively.ConclusionsPressureEasy® did not demonstrate a better control of Pcuff between 20 and 30 cmH2O, compared with routine care using a manometer. Moreover, the device use resulted in significantly higher time spent with overinflation of tracheal cuff, which might increase the risk for tracheal ischemic lesions.Trial registrationClinicaltrial.gov: NCT02109003

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Tracheal Cuff Management as Part of a Lung-Protective Strategy

Cited by 2 publications

References 14 publications

Cardiovascular involvement in COVID-19: not to be missed

Cardiovascular involvement in COVID-19: not to be missed

Efficiency of a mechanical device in controlling tracheal cuff pressure in intubated critically ill patients: a randomized controlled study

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