title: Association among duration of mechanical ventilation, cuff material of endotracheal tube, and postoperative nosocomial pneumonia in cardiac surgical patients: a prospective study.
abstract: OBJECTIVE
  Postoperative pulmonary complications are a burden for high-risk surgical patients with a risk of aspiration of subglottic secretions along the polyvinyl chloride cuff. The introduction of a polyurethane cuff diminishes secretion leakage with a decreased rate of pneumonia. The aim of the current analysis was to determine the time at which a polyurethane cuffed endotracheal tube might be advantageous to prevent aspiration in a setting of high-risk surgical patients.
  
  
  METHODS
  The present investigation is based on published data obtained in postoperative cardiac surgical patients undergoing operation from 2006 to 2007. Cuff pressure was kept between 20 and 26 cmH2O intraoperatively and in the intensive care unit. The current post hoc analysis determines (1) the discriminatory cutoff value of intubation duration for predicting postoperative pneumonia and (2) the potential factors associated with prolonged intubation.
  
  
  RESULTS
  Forty-three patients (32%) were diagnosed with early postoperative pneumonia. Receiver operating characteristics analysis revealed a cutoff value of 16.6 hours for the duration of mechanical ventilation to discriminate patients with postoperative pneumonia. A stepwise binary logistic regression analysis revealed that a polyvinyl chloride cuff was associated with a 10-fold increased risk for prolonged intubation.
  
  
  CONCLUSIONS
  The current analyses provide evidence that among cardiac surgical patients, mechanical ventilation more than 16.6 hours is associated with an increased likelihood of postoperative pneumonia.
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, Faculty of Medicine and Pharmacology, Vrije Universiteit Brussel, Brussels, Belgium. Electronic address: Jan.poelaert@uzbrussel.be.
authors.forename: Jan
authors.initials: J
authors.lastname: Poelaert
authors.affiliation: Center for Outcomes Research and Laboratory for Experimental Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Haentjens
authors.affiliation: Department of Internal Medicine, Ghent University, Ghent, Belgium.
authors.forename: Stijn
authors.initials: S
authors.lastname: Blot
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D003428:Cross Infection / Q000453:epidemiology*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation; D008297:Male; D011015:Pneumonia, Aspiration / Q000453:epidemiology*; D011140:Polyurethanes; D011143:Polyvinyl Chloride / Q000009:adverse effects; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D012307:Risk Factors; D013997:Time Factors
chemical_list: D011140:Polyurethanes; D011143:Polyvinyl Chloride