Effectiveness of continuous endotracheal cuff pressure control for the prevention of ventilator associated respiratory infections: an open-label randomised, controlled trial.
Dat VQ., Yen LM., Loan HT., Phu VD., Binh NT., Geskus RB., Trinh DHK., Mai NTH., Phu NH., Phu Huong Lan N., Thuy TP., Trung NV., Trung Cap N., Trinh DT., Hoa NT., Van NTT., Luan VTT., Nhu TTQ., Long HB., Ha NTT., Van NTT., Campbell J., Ahmadnia E., Kestelyn E., Wyncoll D., Thwaites GE., Van Hao N., Chien LT., Van Kinh N., Van Vinh Chau N., van Doorn HR., Thwaites CL., Nadjm B.
An endotracheal tube cuff pressure between 20-30 cmH2O is recommended to prevent ventilator-associated respiratory infection (VARI). We aimed to evaluate whether continuous cuff pressure control (CPC) was associated with reduced VARI incidence compared with intermittent CPC. We conducted a multi-centre open-label randomised controlled trial in intensive care unit (ICU) patients within 24 hours of intubation in Vietnam. Patients were randomly assigned 1:1 to receive either continuous CPC using an automated electronic device or intermittent CPC using a manually hand-held manometer. The primary endpoint was the occurrence of VARI, evaluated by an independent reviewer blinded to the CPC allocation. We randomised 600 patients, 597 received the intervention or control and were included in the intention to treat analysis. Compared with intermittent CPC, continuous CPC did not reduce the proportion of patients with at least one episode of VARI [74/296 (25%) vs. 69/301 (23%); odds ratio (OR) 1.13; 95%CI 0.77-1.67]. There were no significant differences between continuous and intermittent CPC concerning the proportion of microbiologically confirmed VARI (OR 1.40; 95%CI 0.94- 2.10), the proportion of intubated days without antimicrobials [relative proportion (RP) 0.99; 95%CI 0.87-1.12], rate of ICU discharge [cause-specific hazard ratio (HR) 0.95; 95%CI 0.78-1.16], cost of ICU stay [difference in transformed mean (DTM) 0.02; 95%CI -0.05-0.08], cost of ICU antimicrobials (DTM 0.02; 95%CI -0.25-0.28), cost of hospital stay (DTM 0.02; 95%CI -0.04-0.08) and ICU mortality risk (OR 0.96; 95%CI 0.67-1.38). Maintaining CPC through an automated electronic device did not reduce VARI incidence. NCT02966392.