Effectiveness of Continuous Endotracheal Cuff Pressure Control for the Prevention of Ventilator-Associated Respiratory Infections: An Open-Label Randomized, Controlled Trial
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| Title: | Effectiveness of Continuous Endotracheal Cuff Pressure Control for the Prevention of Ventilator-Associated Respiratory Infections: An Open-Label Randomized, Controlled Trial |
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| Authors: | Nguyen Phu Huong Lan, Nguyen Thien Binh, Evelyne Kestelyn, Guy E. Thwaites, Vu Dinh Phu, Nguyen Van Kinh, Ninh Thi Thanh Van, H. Rogier van Doorn, James Campbell, Tran Phuong Thuy, Nguyen Vu Trung, Nguyen Van Hao, Nguyen Van Vinh Chau, Huynh Thi Loan, Vu Quoc Dat, Nguyen Thi Thu Van, Ronald B. Geskus, Vy Thi Thu Luan, Duncan Wyncoll, Behzad Nadjm, Nguyen Trung Cap, Le Thanh Chien, Nguyen Hoan Phu, Lam Minh Yen, Dong Huu Khanh Trinh, Nguyen Thi Hoa, Ehsan Ahmadnia, Nguyen Thi Hoang Mai, Tran Thi Quynh Nhu, C. Louise Thwaites, Hoang Bao Long, Nguyen Thi Thanh Ha, Dao Tuyet Trinh |
| Source: | Clin Infect Dis |
| Publisher Information: | Oxford University Press (OUP), 2021. |
| Publication Year: | 2021 |
| Subject Terms: | Pulmonary and Respiratory Medicine, Assessment of Decisional Capacity in Psychiatry, Hazard ratio, Social Sciences, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Management of Ventilator-associated Pneumonia in ICU Patients, Health Sciences, Intubation, Intratracheal, Humans, Psychology, Intensive care unit, Anesthesia, Respiratory Tract Infections, Internal medicine, Ventilators, Mechanical, Positive End-Expiratory Pressure, Confidence interval, Pneumonia, Ventilator-Associated, Cuff, Odds ratio, Length of Stay, 3. Good health, FOS: Psychology, Mechanical Ventilation in Respiratory Failure and ARDS, Major Articles and Commentaries, Clinical Psychology, Randomized controlled trial, Medicine, Surgery, Intubation |
| Description: | Background An endotracheal tube cuff pressure between 20 and 30 cmH2O is recommended to prevent ventilator-associated respiratory infection (VARI). We aimed to evaluate whether continuous cuff pressure control (CPC) was associated with reduced VARI incidence compared with intermittent CPC. Methods We conducted a multicenter open-label randomized controlled trial in intensive care unit (ICU) patients within 24 hours of intubation in Vietnam. Patients were randomly assigned 1:1 to receive either continuous CPC using an automated electronic device or intermittent CPC using a manually hand-held manometer. The primary endpoint was the occurrence of VARI, evaluated by an independent reviewer blinded to the CPC allocation. Results We randomized 600 patients; 597 received the intervention or control and were included in the intention to treat analysis. Compared with intermittent CPC, continuous CPC did not reduce the proportion of patients with at least one episode of VARI (74/296 [25%] vs 69/301 [23%]; odds ratio [OR] 1.13; 95% confidence interval [CI] .77–1.67]. There were no significant differences between continuous and intermittent CPC concerning the proportion of microbiologically confirmed VARI (OR 1.40; 95% CI .94–2.10), the proportion of intubated days without antimicrobials (relative proportion [RP] 0.99; 95% CI .87–1.12), rate of ICU discharge (cause-specific hazard ratio [HR] 0.95; 95% CI .78–1.16), cost of ICU stay (difference in transformed mean [DTM] 0.02; 95% CI −.05 to .08], cost of ICU antimicrobials (DTM 0.02; 95% CI −.25 to .28), cost of hospital stay (DTM 0.02; 95% CI −.04 to .08), and ICU mortality risk (OR 0.96; 95% CI .67–1.38). Conclusions Maintaining CPC through an automated electronic device did not reduce VARI incidence. Clinical Trial Registration NCT02966392. |
| Document Type: | Article Other literature type |
| Language: | English |
| ISSN: | 1537-6591 1058-4838 |
| DOI: | 10.1093/cid/ciab724 |
| DOI: | 10.60692/e6znv-6ms11 |
| DOI: | 10.60692/09zzs-1p918 |
| Access URL: | https://academic.oup.com/cid/advance-article-pdf/doi/10.1093/cid/ciab724/40833885/ciab724.pdf https://pubmed.ncbi.nlm.nih.gov/34420048 https://europepmc.org/article/MED/34420048 https://pubmed.ncbi.nlm.nih.gov/34420048/ https://www.ncbi.nlm.nih.gov/pubmed/34420048 |
| Rights: | CC BY URL: http://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
| Accession Number: | edsair.doi.dedup.....d5cfcae332879d9cf357a586c5e08e34 |
| Database: | OpenAIRE |
Nájsť tento článok vo Web of Science | Abstract: | Background An endotracheal tube cuff pressure between 20 and 30 cmH2O is recommended to prevent ventilator-associated respiratory infection (VARI). We aimed to evaluate whether continuous cuff pressure control (CPC) was associated with reduced VARI incidence compared with intermittent CPC. Methods We conducted a multicenter open-label randomized controlled trial in intensive care unit (ICU) patients within 24 hours of intubation in Vietnam. Patients were randomly assigned 1:1 to receive either continuous CPC using an automated electronic device or intermittent CPC using a manually hand-held manometer. The primary endpoint was the occurrence of VARI, evaluated by an independent reviewer blinded to the CPC allocation. Results We randomized 600 patients; 597 received the intervention or control and were included in the intention to treat analysis. Compared with intermittent CPC, continuous CPC did not reduce the proportion of patients with at least one episode of VARI (74/296 [25%] vs 69/301 [23%]; odds ratio [OR] 1.13; 95% confidence interval [CI] .77–1.67]. There were no significant differences between continuous and intermittent CPC concerning the proportion of microbiologically confirmed VARI (OR 1.40; 95% CI .94–2.10), the proportion of intubated days without antimicrobials (relative proportion [RP] 0.99; 95% CI .87–1.12), rate of ICU discharge (cause-specific hazard ratio [HR] 0.95; 95% CI .78–1.16), cost of ICU stay (difference in transformed mean [DTM] 0.02; 95% CI −.05 to .08], cost of ICU antimicrobials (DTM 0.02; 95% CI −.25 to .28), cost of hospital stay (DTM 0.02; 95% CI −.04 to .08), and ICU mortality risk (OR 0.96; 95% CI .67–1.38). Conclusions Maintaining CPC through an automated electronic device did not reduce VARI incidence. Clinical Trial Registration NCT02966392. |
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| ISSN: | 15376591 10584838 |
| DOI: | 10.1093/cid/ciab724 |