scholarly journals Continuous Pneumatic Regulation of Tracheal Cuff Pressure to Decrease Ventilator-associated Pneumonia in Trauma Patients Who Were Mechanically Ventilated

CHEST Journal ◽  
2021 ◽  
Author(s):  
Nicolas Marjanovic ◽  
Matthieu Boisson ◽  
Karim Asehnoune ◽  
Arnaud Foucrier ◽  
Sigismond Lasocki ◽  
...  
Keyword(s):  
Cuff Pressure ◽  
Trauma Patients ◽  
Ventilator Associated Pneumonia ◽  
Mechanically Ventilated ◽  
Tracheal Cuff

scholarly journals Multicentre randomised controlled trial to investigate the usefulness of continuous pneumatic regulation of tracheal cuff pressure for reducing ventilator-associated pneumonia in mechanically ventilated severe trauma patients: the AGATE study protocol

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e017003 ◽  
Author(s):  
Nicolas Marjanovic ◽  
Denis Frasca ◽  
Karim Asehnoune ◽  
Catherine Paugam ◽  
Sigismond Lasocki ◽  
...  
Keyword(s):  
Cuff Pressure ◽  
Invasive Mechanical Ventilation ◽  
Severe Trauma ◽  
Control Group ◽  
Trauma Patients ◽  
Intermittent Control ◽  
Ventilator Associated Pneumonia ◽  
Pneumatic Device ◽  
Randomised Controlled ◽  
Tracheal Cuff

IntroductionSevere trauma represents the leading cause of mortality worldwide. While 80% of deaths occur within the first 24 hours after trauma, 20% occur later and are mainly due to healthcare-associated infections, including ventilator-associated pneumonia (VAP). Preventing underinflation of the tracheal cuff is recommended to reduce microaspiration, which plays a major role in the pathogenesis of VAP. Automatic devices facilitate the regulation of tracheal cuff pressure, and their implementation has the potential to reduce VAP. The objective of this work is to determine whether continuous regulation of tracheal cuff pressure using a pneumatic device reduces the incidence of VAP compared with intermittent control in severe trauma patients.Methods and analysisThis multicentre randomised controlled and open-label trial will include patients suffering from severe trauma who are admitted within the first 24 hours, who require invasive mechanical ventilation to longer than 48 hours. Their tracheal cuff pressure will be monitored either once every 8 hours (control group) or continuously using a pneumatic device (intervention group). The primary end point is the proportion of patients that develop VAP in the intensive care unit (ICU) at day 28. The secondary end points include the proportion of patients that develop VAP in the ICU, early (≤7 days) or late (>7 days) VAP, time until the first VAP diagnosis, the number of ventilator-free days and antibiotic-free days, the length of stay in the ICU, the proportion of patients with ventilator-associated events and that die during their ICU stay.Ethics and disseminationThis protocol has been approved by the ethics committee of Poitiers University Hospital, and will be carried out according to the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results of this study will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals.Trial registrationClinical TrialsNCT02534974

scholarly journals EARLY PROBIOTICS IN PREVENTING VENTILATOR-ASSOCIATED PNEUMONIA AFTER MULTIPLE TRAUMA

2020 ◽  
pp. 83-85
Author(s):  
TAMER HABIB ◽  
AMIRA B KASSEM ◽  
ISLAM AHMED
Keyword(s):  
Multiple Trauma ◽  
University Hospital ◽  
Control Group ◽  
Trauma Patients ◽  
Ventilator Associated Pneumonia ◽  
Mechanically Ventilated ◽  
Significant Difference ◽  
Multiple Trauma Patients ◽  
And Control

Objective: Using probiotics in preventing ventilator-associated pneumonia (VAP) remain controversial due to different intensive care unit (ICU) populations included in such studies. The aim of this study is to evaluate the role of probiotics in prophylaxis of VAP after multiple trauma. Methods: Sixty-five adult multiple trauma patients on mechanical ventilator (expected ≥48 h) after admission to the Critical Care Medicine Department, Alexandria Main University Hospital from June to November 2018. Patients were randomly assigned using computer sheet into two groups; probiotics group (32 patients received one Lacteol Forte® sachet through orogastric/nasogastric tube 3 times daily during their ICU stay) and control group (33 patients received similar regimen of placebo sachets). All patients were followed up and subjected to all possible strategies of the diagnosis of microbiologically confirmed VAP. Results: Sixty-five patients were enrolled with a mean of age (39.48±7.692) years, 80% of them were male. Regarding the incidence of VAP, it was 18.46% of all patients without statistically significant difference between probiotics group (15.63%) and control group (21.21%) (p=0.751). Conclusion: Routine use of early probiotics in mechanically ventilated multiple trauma patients was not associated with lower incidence of VAP, duration of MV, or ICU mortality.

scholarly journals The influence of the endotracheal tube cuff on the occurrence of ventilator-associated pneumonia

2015 ◽  
Vol 49 (3) ◽  
Author(s):  
Marko Kučan ◽  
Bernarda Djekić ◽  
Mirjam Ravljen
Keyword(s):  
Endotracheal Tube ◽  
Qualitative Content Analysis ◽  
Cuff Pressure ◽  
Preventive Measure ◽  
Ventilator Associated Pneumonia ◽  
Endotracheal Tube Cuff ◽  
Eligibility Criteria ◽  
Mechanically Ventilated ◽  
Tube Cuff ◽  
Practical Applications

Introduction: An endotracheal tube enables patient ventilation, but also presents a risk of complications. The accumulation of subglottic secretions above the cuff may cause ventilatorassociated pneumonia. The purpose of the article is to establish the effect of the endotracheal tube cuff (shape and material, method of inflation, verifying and maintaining pressure) on the incidence of ventilator-associated pneumonia. Methods: A descriptive method with a systematic review of domestic and foreign literature was used. The literature was retrieved from electronic databases and the cooperative bibliographic/catalogue database. According to eligibility criteria, sixteen original scientific articles published in the last ten years were finally used. Data were processed with qualitative content analysis. Results: Cuff inflation control with a manometer and continuous measuring and adjustment of cuff pressure with modern equipment were found to be the safest methods. According to the articles on shape and material, conical polyurethane cuffs provide the best sealing. Discussion and conclusion: Ventilator-associated pneumonia is a serious complication in mechanically ventilated patients. Maintaining appropriate cuff pressure proved to be a very effective preventive measure. The research presented here is limited by the small number of available articles. Further research is needed before practical applications are attempted.

scholarly journals Transesophageal echocardiography-associated tracheal microaspiration and ventilator-associated pneumonia in intubated critically ill patients: a multicenter prospective observational study

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
François Bagate ◽  
Anahita Rouzé ◽  
Farid Zerimech ◽  
Florence Boissier ◽  
Vincent Labbe ◽  
...  
Keyword(s):  
Observational Study ◽  
Transesophageal Echocardiography ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Cuff Pressure ◽  
Ventilator Associated Pneumonia ◽  
Salivary Amylase ◽  
Before And After ◽  
Tracheal Cuff

Abstract Background Microaspiration of gastric and oropharyngeal secretions is the main causative mechanism of ventilator-associated pneumonia (VAP). Transesophageal echocardiography (TEE) is a routine investigation tool in intensive care unit and could enhance microaspiration. This study aimed at evaluating the impact of TEE on microaspiration and VAP in intubated critically ill adult patients. Methods It is a four-center prospective observational study. Microaspiration biomarkers (pepsin and salivary amylase) concentrations were quantitatively measured on tracheal aspirates drawn before and after TEE. The primary endpoint was the percentage of patients with TEE-associated microaspiration, defined as: (1) ≥ 50% increase in biomarker concentration between pre-TEE and post-TEE samples, and (2) a significant post-TEE biomarker concentration (> 200 μg/L for pepsin and/or > 1685 IU/L for salivary amylase). Secondary endpoints included the development of VAP within three days after TEE and the evolution of tracheal cuff pressure throughout TEE. Results We enrolled 100 patients (35 females), with a median age of 64 (53–72) years. Of the 74 patients analyzed for biomarkers, 17 (23%) got TEE-associated microaspiration. However, overall, pepsin and salivary amylase levels were not significantly different between before and after TEE, with wide interindividual variability. VAP occurred in 19 patients (19%) within 3 days following TEE. VAP patients had a larger tracheal tube size and endured more attempts of TEE probe introduction than their counterparts but showed similar aspiration biomarker concentrations. TEE induced an increase in tracheal cuff pressure, especially during insertion and removal of the probe. Conclusions We could not find any association between TEE-associated microaspiration and the development of VAP during the three days following TEE in intubated critically ill patients. However, our study cannot formally rule out a role for TEE because of the high rate of VAP observed after TEE and the limitations of our methods.

scholarly journals Ventilator-associated Pneumonia Leading to Acute Lung Injury after Trauma

2006 ◽  
Vol 104 (2) ◽  
pp. 235-241 ◽  
Author(s):  
François Stéphan ◽  
Nejma Mabrouk ◽  
François Decailliot ◽  
Christophe Delclaux ◽  
Patrick Legrand
Keyword(s):  
Risk Factor ◽  
Acute Lung Injury ◽  
Lung Injury ◽  
Independent Risk Factor ◽  
Bacterial Culture ◽  
Trauma Patients ◽  
Ventilator Associated Pneumonia ◽  
Mechanically Ventilated ◽  
Colony Forming Units ◽  
Multiple Trauma Patients

Background Ventilator-associated pneumonia is a clear risk factor for acute lung injury which has been poorly described in trauma patients. This prospective study was undertaken to estimate the incidence of such ventilator-associated pneumonia leading to acute lung injury, the risk factors, and the associated morbidity and mortality in a group of multiple trauma patients. Methods Trauma patients who were mechanically ventilated and survived at least 24 h were included. Ventilator-associated pneumonia was confirmed by a bacterial culture of a blind protected telescoping catheter with at least 10 colony-forming units/ml of at least one pathogen. Episodes of acute lung injury were prospectively recorded. Results Ventilator-associated pneumonia was documented in 78 patients of the 175 included (44%) and led to the development of ventilator-associated pneumonia acute lung injury in 18 patients (23%). The sole independent risk factor for ventilator-associated pneumonia leading to acute lung injury was the presence of Haemophilus influenzae (hazard ratio, 8.8; 95% confidence interval, 2.7-28.6). Eleven (61%) of the 18 patients with ventilator-associated pneumonia leading to acute lung injury had development of a ventilator-associated pneumonia recurrence, as compared with 20 (33%) of the 60 patients with ventilator-associated pneumonia alone (P = 0.03). Seven (39%) of the 18 trauma patients with ventilator-associated pneumonia leading to acute lung injury died, as compared with 9 (15%) of the 60 trauma patients with ventilator-associated pneumonia alone (P = 0.04). Conclusion Acute lung injury complicated the course of 15% of ventilator-associated pneumonia in trauma patients. H. influenzae seemed to be one of the most frequent bacteria involved and the sole risk factor identified. Occurrence of ventilator-associated pneumonia leading to acute lung injury modified the prognosis of trauma patients.

Bronchoscopy Decreases Ventilator-Associated Pneumonia in Trauma Patients

2021 ◽  
pp. 000313482110586
Author(s):  
Siddhartha Nannapaneni ◽  
Jennifer Silvis ◽  
Karleigh Curfman ◽  
Timothy Chung ◽  
Thomas Simunich ◽  
...  
Keyword(s):  
Traumatic Injury ◽  
Trauma Surgery ◽  
Trauma Patients ◽  
Ventilator Associated Pneumonia ◽  
Mechanically Ventilated ◽  
Control And Prevention ◽  
Definition Of ◽  
Record Review ◽  
Level 1 Trauma Center ◽  
Ventilated Patients

Health care-associated pneumonias (HAPs) are a significant comorbidity seen in hospitalized patients. Traumatic injury is a known independent risk factor for the development of HAP. Trauma-related injuries also contribute to an increase in the rate of pneumonia in mechanically ventilated patients requiring intensive care unit (ICU) treatment. In 2011, the ventilator-associated pneumonia (VAP) rate among ICU patients at our institution (CMMC) increased dramatically. As a result, our infection control specialists performed a focused review of these patients and found a likely association between these infections and patients requiring pre-hospital intubation. Their determination prompted a July 2012 revision of the CMMC Trauma/Surgery Admission ICU protocol for ventilated patients to include bronchoscopy for all patients who have been intubated pre-hospital providing no contraindications were present. Our aim was to ascertain any influence of the protocol change on the rate of VAP. We conducted a retrospective medical record review of trauma patients who were intubated in the field or ED and seen at our institution (an accredited Level 1 trauma center) from 2012 to 2018. Applying the current definition of VAP from the Centers for Disease Control and Prevention (CDC) to data collected from the CMMC trauma registry, we observed a 13% lower VAP rate in the bronchoscopy group ( YB) as compared to the group that did not receive bronchoscopy (NB) ( P < .025). Based on our results, we determined that bronchoscopy performed in this setting does support a statistically significant decrease in the rate of ventilator-associated pneumonia.

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