ABSTRACT

Objective:

To investigate the effect of endotracheal tube cuff pressure control on microaspiration and ventilator-associated pneumonia.

Materials and Methods:

This study was created by using the Preferred Reporting Items for Systematic Review and Meta Analysis - Meta Analyzer checklist. Among the electronic databases, Medline/PUBMED, Scopus, Cochrane Library and Google Scholar were scanned for articles published before September 2018 and 1311 studies were reached. After reviewing the eligibility and exclusion criteria, seven experimental/quasi-experimental studies were included. The studies were evaluated with the Turkish Joanna Briggs Institute-Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) Critical Appraisal Checklist in terms of methodological quality.

Results:

In one study, intermittent control method was used to avoid using any control method and intermittent control method was used despite pilot balloon finger palpation control method in another study. As a result of the methodological quality evaluations of the studies, the lowest score was five and the highest score was nine. It was determined that intermittent and continuous endotracheal tube cuff pressure control method was the most frequently used method in the studies. The incidence of microaspiration was 18% to 80% in three studies, and the incidence of ventilator-associated pneumonia was 2.7% to 67.7% in five studies.

Conclusion:

When the endotracheal tube cuff pressure control method is not used, it is seen that the incidence of microspiration and ventilator-associated pneumonia increases, the methods used are superior to each other, and continuous endotracheal tube cuff pressure control method is recommended to prevent microspiration and ventilator associated pneumonia.

Keywords: Nursing, cuff pressure, microaspiration, ventilator associated pneumonia, intensive care

References

Lapinsky SE. Endotracheal intubation in the ICU. Crit Care 2015;19:1-3.

Gümüş N, Dilek A, Ülger F, Köksal E, Çetinoğlu EÇ, Özkan M, et at. Comparison of LMA CTrach and Video Laryngoscope in Endotracheal Intubation. Turk J Anesth Reanim 2014;42:251-6.

Gündoğan K, Coşkun R, Guven M, Sungur M. Complications of Endotracheal Intubation in Intensive Care Unit. Dahili Ve Cerrahi Bilim Yoğun Bakım Derg Turk J Med Surg Intensive Care 2011;2:39-43.

Olgun N, Eti Aslan F, Çil Akıncı A. Toraks ve Alt Solunum Sistemi Hastalıkları. Içinde: Dahili ve Cerrahi Hastalıklarda Bakım. 2. Adana: Nobel Kitabevi; 2011. s. 419-22.

Kapucu S, Özden G. Ventilator Associated Pneumonia and Nursing Care. Hacet Üniversitesi Hemşire Fakültesi Derg 2014;1:99-110.

Rouzé A, Nseir S. Continuous control of tracheal cuff pressure for the prevention of ventilator-associated pneumonia in critically ill patients: where is the evidence? Curr Opin Crit Care 2013;19:440-7.

Blot SI, Rello J, Koulenti D. The value of polyurethane-cuffed endotracheal tubes to reduce microaspiration and intubation-related pneumonia: a systematic review of laboratory and clinical studies. Crit Care 2016;20:203.

Dewavrin F, Zerimech F, Boyer A, Maboudou P, Balduyck M, Duhamel A, vd. Accuracy of Alpha Amylase in Diagnosing Microaspiration in Intubated Critically-Ill Patients. Stover CM, editör. PLoS ONE. 2014;9:1-8.

Nseir S, Lorente L, Ferrer M, Rouzé A, Gonzalez O, Bassi GL, et al. Continuous control of tracheal cuff pressure for VAP prevention: a collaborative meta-analysis of individual participant data. Ann Intensive Care 2015;5:43.

Blot SI, Poelaert J, Kollef M. How to avoid microaspiration? A key element for the prevention of ventilator-associated pneumonia in intubated ICU patients. BMC Infect Dis. 2014;14:119.

Lizy C, Swinnen W, Labeau S, Blot S. Deviations in Endotracheal Cuff Pressure During Intensive Care. Am J Crit Care 2011;20:421-2.

Baskan S. Postoperative Pneumonia: Preventive Methods and Supportive Therapy. ANKEM Derg 2010;24:152-6.

Farré R, Rotger M, Ferrer M, Torres A, Navajas D. Automatic regulation of the cuff pressure in endotracheally-intubated patients. Eur Respir J 2002;20:1010-3.

Schallom M, Tricomi SM, Chang Y-H, Metheny NA. A pilot study of pepsin in tracheal and oral secretions. Am J Crit Care Off Publ Am Assoc Crit-Care Nurses 2013;22:408-11.

Rello J, Ollendorf DA, Oster G, Vera-Llonch M, Bellm L, Redman R, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 2002;122:2115-21.

Liu J, Zhang X, Gong W, Li S, Wang F, Fu S, et al. Correlations between controlled endotracheal tube cuff pressure and postprocedural complications: a multicenter study. Anesth Analg 2010;111:1133-7.

Sole ML, Aragon D, Bennett M, Johnson RL. Continuous Measurement of Endotracheal Tube Cuff Pressure: How Difficult Can It Be? AACN Adv Crit Care 2008;19:235-43.

Park YJ, Lee J, Kim SH, Ko SH, Shin MJ, Chang JH, et al. Care Status of the ALS Patients With Long-Term Use of Tracheostomy Tube. Ann Rehabil Med 2015;39:964-70.

Seçginli S. Hemşirelikte Araştırma Kullanımı ve Kanıta Dayalı Uygulamalar. Içinde: Hemşirelikte Araştırma Süreç, Uygulama ve Kritik. 1. bs İstanbul: Nobel Tıp Kitabevi; 2014. s. 346.

Karaçam Z. Systematic Review Methodology: A Guide for Preparation of Systematic Review. Dokuz Eylül Üniversitesi Hemşire Fakültesi Elektron Derg 2014;6:26-33.

Nahcivan N, Seçginli S. Sistematik Derlemeye Dahil Edilen Nicel Araştırmaların Metodolojik Kalitesi Nasıl Değerlendirilir? Turk Klin Public Health Nurs - Spec Top 2017;3:10-9.

Nseir S, Zerimech F, Fournier C, Lubret R, Ramon P, Durocher A, et al. Continuous Control of Tracheal Cuff Pressure and Microaspiration of Gastric Contents in Critically Ill Patients. Am J Respir Crit Care Med 2011;184:1041-7.

Rouzé A, De Jonckheere J, Zerimech F, Labreuche J, Parmentier-Decrucq E, Voisin B, vd. Efficiency of an electronic device in controlling tracheal cuff pressure in critically ill patients: a randomized controlled crossover study. Ann Intensive Care 2016;6:1-8.

Lorente L, Lecuona M, Jiménez A, Lorenzo L, Roca I, Cabrera J, et al. Continuous endotracheal tube cuff pressure control system protects against ventilator-associated pneumonia. Crit Care. 2014;18:1-8.

Valencia M, Ferrer M, Farre R, Navajas D, Badia JR, Nicolas JM, et al. Automatic control of tracheal tube cuff pressure in ventilated patients in semirecumbent position: A randomized trial. Crit Care Med. 2007;35:1543-9.

Akdogan O, Ersoy Y, Kuzucu C, Gedik E, Togal T, Yetkin F. Assessment of the effectiveness of a ventilator associated pneumonia prevention bundle that contains endotracheal tube with subglottic drainage and cuff pressure monitorization. Braz J Infect Dis Off Publ Braz Soc Infect Dis 2017;21:276-81.

De Pascale G, Pennisi MA, Vallecoccia MS, Bello G, Maviglia R, Montini L, et al. CO2 driven endotracheal tube cuff control in critically ill patients: A randomized controlled study. - PubMed - NCBI. PLoS One 2017;12:e0175476.

Kamrani F, Feizi A, Khalkhali HR, Amin M. Impact Of Endotracheal Tube Cuff Pressure Monitoring On Micro Aspiration Of Gastric Contents. Int J Pharm Phytopharm Res 2017;7:43-9.

Jaillette E, Brunin G, Girault C, Zerimech F, Chiche A, Broucqsault-Dedrie C, et al. Impact of tracheal cuff shape on microaspiration of gastric contents in intubated critically ill patients: study protocol for a randomized control. Trials 2015;16:1-9.

Rouzé A, Jaillette E, Poissy J, Préau S, Nseir S. Tracheal Tube Design and Ventilator-Associated Pneumonia. Respir Care 2017;62:1316-23.

The Effect of Endotracheal Tube Cuff Pressure Control on the Development of Microaspiration and Ventilator- Associated Pneumonia: Systematic Review

ABSTRACT

References