title: The LoTrach system: its role in the prevention of ventilator-associated pneumonia.
abstract: OBJECTIVE
  To discuss the development of the LoTrach system in light of current evidence around the prevention of ventilator-associated pneumonia (VAP) and its practical application in the intensive care setting.
  
  
  BACKGROUND
  VAP causes substantial morbidity and mortality in ventilated patients in the Intensive Care Unit (ICU), increases length of stay in ICU and is extremely costly. Strategies are needed to reduce the risk of VAP.
  
  
  METHODS
  We examine the need for an endotracheal tube (ETT) specifically designed for the critically-ill patient, the development of the LoTrach system from conception to production, and the role of the various components of the system in preventing VAP. Early issues in implementing this revolutionary equipment into ICU are explored and three case studies highlight advantages of this system.
  
  
  CONCLUSIONS
  The LoTrach system has been designed to facilitate the provision of a number of evidence-based interventions that have been shown to reduce VAP. Pulmonary aspiration is ubiquitous with conventional cuffs but prevented by the cuff of the LoTrach system when held at a constant and safe pressure against the tracheal wall with a cuff pressure controller. Other aspects incorporated in the ETT are aimed at clearing the secretions from the subglottic space, preventing tube occlusion and accidental extubation, and avoiding damage to the airway. In this way the LoTrach system employs a multifactorial approach to the prevention of VAP and the cost savings from LoTrach rather than a standard ETT will be considerable because of an average 3 day reduction in ICU length of stay related to this. It thus has the potential to be a very useful tool in the ICU setting in the prevention of VAP.
authors.affiliation: Queen Elizabeth Hospital, King's Lynn, Norfolk, UK.
authors.forename: Andrew J W
authors.initials: AJ
authors.lastname: Fletcher
authors.forename: Alison J
authors.initials: AJ
authors.lastname: Ruffell
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Young
mesh_terms: D000328:Adult; D000368:Aged; D004867:Equipment Design; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D053120:Respiratory Aspiration / Q000517:prevention & control; D013396:Suction / Q000295:instrumentation; D007507:Therapeutic Irrigation / Q000295:instrumentation