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Low Endotracheal Cuff Pressures in Mechanically Ventilated Adult Patients Is Associated With an Increased Incidence of Ventilator-Associated Pneumonia FREE TO VIEW

Amabelle Trina Gerona, MD; Jose Paolo Panuda, MD; Rylene Baquilod, MD; Albert Rafanan, MD
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Chong Hua Hospital, Cebu City, Philippines

Chest. 2015;148(4_MeetingAbstracts):319A. doi:10.1378/chest.2272655
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SESSION TITLE: Mechanical Ventilation Poster Discussion

SESSION TYPE: Original Investigation Poster Discussion

PRESENTED ON: Tuesday, October 27, 2015 at 02:45 PM - 04:15 PM

PURPOSE: Despite strict implementation of a ventilator-associated pneumonia (VAP) protocol in our institution, the incidence of VAP has remained high. There is no strict policy on the standardization of endotracheal (ET) cuff pressure in our hospital. With under inflation of the ET cuff, there is increased risk of aspiration of oropharyngeal secretions, and potentially increases the risk of VAP. The aim of this study was to determine if the incidence of VAP among mechanically ventilated patients was affected by ET cuff pressure as measured by a Posey CufflatorTM.

METHODS: All patients admitted on July 2013 that required mechanical ventilation were screened for eligibility. Fifty-five patients were included in the study and were followed throughout their hospital course. Once daily ET cuff pressures were taken by trained respiratory therapists and recorded. All mechanically ventilated patients were assessed daily for VAP. Chi Square Test of Independence was used to compare the rates VAP across the different levels of ET cuff pressures.

RESULTS: Of the 87 patients that needed mechanical ventilation, 55 were eligible for the study while the remaining 32 did not fulfill the inclusion criteria. There were a total of 452 endotracheal tube cuff pressure readings done on the study patients. Using the cuff pressure gauge, the incidence of underinflation (<25 cm H20) was 87.6%(n=396), overinflation (>40 cm H20) was 3.5% (n=16), and only 8.8%( n=40) had normal (25-40 cm H20) ET cuff pressures. VAP developed in 60% (33 out of 55) of the study population. Out of the 33 patients with VAP, 94% (n=31) had under-inflation readings with a mean frequency of 7.4 times (range 1-19 readings done), 39% (n=13) had normal readings with mean frequency of 3.00 (range 1-22), while 12% (n=4) had overinflated ET cuff pressure readings with mean frequency of 1.3 (range 1-22) (p=0.0001). The differences in the incidence of VAP across the different levels of cuff pressure categories were statistically significant with a 95% level of confidence.

CONCLUSIONS: In our study, we found that ET cuff pressures are commonly underinflated. VAP was common among mechanically ventilated patients and their frequency was greater in patients who had an underinflated ET cuff (pressure <25cm H2O).

CLINICAL IMPLICATIONS: A protocol to closely monitor ET cuff pressures should be in place to avoid underinflation as cuff pressures below 25 cm H2O are associated with increased incidence of ventilator-associated pneumonia.

DISCLOSURE: The following authors have nothing to disclose: Amabelle Trina Gerona, Jose Paolo Panuda, Rylene Baquilod, Albert Rafanan

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