title: Continuous control of tracheal cuff pressure and microaspiration of gastric contents in critically ill patients.
abstract: BACKGROUND
  Underinflation of the tracheal cuff frequently occurs in critically ill patients and represents a risk factor for microaspiration of contaminated oropharyngeal secretions and gastric contents that plays a major role in the pathogenesis of ventilator-associated pneumonia (VAP).
  
  
  OBJECTIVE
  To determine the impact of continuous control of tracheal cuff pressure (P(cuff)) on microaspiration of gastric contents.
  
  
  METHODS
  Prospective randomized controlled trial performed in a single medical intensive care unit. A total of 122 patients expected to receive mechanical ventilation for at least 48 hours through a tracheal tube were randomized to receive continuous control of P(cuff) using a pneumatic device (intervention group, n = 61) or routine care of P(cuff) (control group, n = 61).
  
  
  RESULTS
  The primary outcome was microaspiration of gastric contents as defined by the presence of pepsin at a significant level in tracheal secretions collected during the 48 hours after randomization. Secondary outcomes included incidence of VAP, tracheobronchial bacterial concentration, and tracheal ischemic lesions. The pneumatic device was efficient in controlling P(cuff). Pepsin was measured in 1,205 tracheal aspirates. Percentage of patients with abundant microaspiration (18 vs. 46%; P = 0.002; OR [95% confidence interval], 0.25 [0.11-0.59]), bacterial concentration in tracheal aspirates (mean ± SD 1.6 ± 2.4 vs. 3.1 ± 3.7 log(10) cfu/ml, P = 0.014), and VAP rate (9.8 vs. 26.2%; P = 0.032; 0.30 [0.11-0.84]) were significantly lower in the intervention group compared with the control group. However, no significant difference was found in tracheal ischemia score between the two groups.
  
  
  CONCLUSIONS
  Continuous control of P(cuff) is associated with significantly decreased microaspiration of gastric contents in critically ill patients.
authors.affiliation: Intensive Care Unit, Biochemistry Division, Pathology and Biology Center, University Hospital of Lille, France. s-nseir@chru-lille.fr
authors.forename: Saad
authors.initials: S
authors.lastname: Nseir
authors.forename: Farid
authors.initials: F
authors.lastname: Zerimech
authors.forename: Clément
authors.initials: C
authors.lastname: Fournier
authors.forename: Rémy
authors.initials: R
authors.lastname: Lubret
authors.forename: Philippe
authors.initials: P
authors.lastname: Ramon
authors.forename: Alain
authors.initials: A
authors.lastname: Durocher
authors.forename: Malika
authors.initials: M
authors.lastname: Balduyck
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D016638:Critical Illness; D004867:Equipment Design; D005260:Female; D005766:Gastrointestinal Contents / Q000737:chemistry; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010434:Pepsin A / Q000032:analysis; D053717:Pneumonia, Ventilator-Associated / Q000209:etiology / Q000517:prevention & control*; D011312:Pressure; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D010434:Pepsin A