Continuous regulation of cuff pressure of the tracheal tube using a pneumatic device was not superior to routine care in preventing ventilator-associated pneumonia (VAP) in patients experiencing severe trauma, according to the results of a large-scale study (ClinicalTrials.gov Identifier: NCT02534974) published in CHEST.
The most frequent health care-associated infection in severely ill patients is VAP and the main route of contamination is aspiration of contaminated oropharyngeal content around the cuff of the tracheal tube. Therefore, researchers sought to determine whether continuous regulation of tracheal cuff pressure using a pneumatic device to prevent VAP in patients would be superior to routine care, which involves manual assessment 3 times daily using a portable manometer.
The researchers conducted an open-label, randomized, controlled, superiority trial in French intensive care units (N=13) that were treating 434 adults experiencing severe trauma and requiring invasive mechanical ventilation for 48 hours or longer between July 31, 2015, and February 15, 2018.
A total of 216 patients were assigned to the intervention group and 218 patients were assigned to the control group. Of these patients, 73 (33.8%) developed at least 1 episode of VAP within 28 days following tracheal intubation in the intervention group compared with 64 patients (29.4%) in the control group (P =.71). There were no serious adverse events related to the use of the pneumatic device.
Several study limitations were noted, including the lack of blinding to the treatment as well as only including patients with severe trauma who required prolonged mechanical ventilation.
“Continuous regulation of tracheal cuff pressure using a pneumatic device was not superior to intermittent control of tracheal cuff pressure using a manual manometer in reducing the incidence of VAP in severe trauma patients,” the study authors concluded. “Further studies taking into account the limitations of the present study are required to definitely conclude on the absence of benefit of the intervention.”
Marjanovic N, Boisson M, Asehnoune K, et al; for the AGATE study group. Continuous pneumatic regulation of tracheal cuff pressure to decrease ventilator-associated pneumonia in mechanically ventilated trauma patients: the AGATE multicenter randomized controlled study. CHEST. Published online March 13, 2021. doi:10.1016/j.chest.2021.03.007