The influence of the endotracheal tube cuff on the occurrence of ventilator-associated pneumonia
DOI:
https://doi.org/10.14528/snr.2015.49.3.52Keywords:
ventilator-associated pneumonia, prevention, cuff pressure, cuff shape, cuff material, nursingAbstract
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.Downloads
Metrics
References
Alijanpour, E., Nikbakhsh, N., Jabbari, A. & Adabi, F., 2013. Endotracheal tube cuff pressure as a risk factor for laryngotracheal sequelae: a 5-years multicenter study. HealthMED, 7(1), pp. 67–71.
Al-Metwalli, R.R., Al-Ghamdi, A.A., Mowafi, H.A., Sadek, S., Abdulshafi, M. & Mousa, W.F., 2011. Is sealing cuff pressure, easy, reliable and safe technique for endotracheal tube cuff inflation? A comparative study. Soudi Journal of Anaesthesia, 5(2), pp. 185–189. http://dx.doi.org/10.4103/1658-354X.82795 PMid:21804801; PMCid:PMC3139313
Blot, S., Rello, J. & Vogelaers, D., 2011. What is new in the prevention of ventilator-associated pneumonia? Current Opinion in Pulmonary Medicine, 17(3), pp. 155–159. http://dx.doi.org/10.1097/MCP.0b013e328344db65 PMid:21326100
Bulpa, P., Evrad, P., Bouhon, S., Schryvers, F., Jamart, J., Michaux, I., et al., 2013. Polyurethane does not protect better than polyvinyl cuffed tracheal tubes from mikroaspirations. Minerva Anesteziologica, 79(5), pp. 498–503. PMid:23511349
Černivec, J., Gagič, R. & Pirš, K., 2002. Oskrba in vzdrževanje lege tubusa. In: Buček Hajdarević, I. ed. Oskrba bolnika, ki potrebuje umetno ventilacijo: zbornik predavanj, Portorož 9. in 10. maj 2002. Ljubljana: Zbornica zdravstvene nege Slovenije – Zveza društev medicinskih sester in zdravstvenih tehnikov Slovenije, Sekcija medicinskih sester in zdravstvenih tehnikov v anesteziologiji, intenzivni terapiji in transfuziologiji, pp. 23–36.
Chow, M.C., Kwok, S.M., Luk, H.W., Law, J.W. & Leung, B.P., 2012. Effect of continuous oral suctioning on the development of ventilator-associated pneumonia: a pilot randomized controlled trial. International Journal of Nursing Studies, 49(11), pp. 1333–1341. http://dx.doi.org/10.1016/j.ijnurstu.2012.06.003 PMid:22749332
Cohen, N.H., 2006. A low-volume, low-pressure tracheal tube may not solve the problem. Critical Care Medicine, 34(3), pp. 900-902. http://dx.doi.org/10.1097/01.CCM.0000202447.80397.46 PMid:16505675
Coppadoro, A., Berra, L. & Bigatello, L.M., 2011. Modifying endotracheal tubes to prevent ventilator-associated pneumonia. Current Opinion in Infectious Diseases, 24(2), pp. 157–162. http://dx.doi.org/10.1097/QCO.0b013e328343b733 PMid:21252657
Craven, D. & Hjalmarson, K.I., 2010. Ventilator-associated tracheobronchitis and pneumonia: thinkin outside the box. Clinical Infectious Diseases, 51(Suppl 1), pp. 59–66. http://dx.doi.org/10.1086/653051 PMid:20597674
Dave, M.H., Frotzler, A., Spielmann, N., Madjdpour, C. & Weiss, M., 2010. Effect of tracheal tube cuff shape on fluid leakage across the cuff: an in vitro study. British Journal of Anaesthesia, 105(4), pp. 538–543. http://dx.doi.org/10.1093/bja/aeq202 PMid:20682571
De, S. & De, S., 2008. Post intubation tracheal stenosis. Indian Journal of Critical Care Medicine, 12(4), pp. 194–197. http://dx.doi.org/10.4103/0972-5229.45081 PMid:19742266 PMCid:PMC2738325
Deem, S. & Treggiari, M.M., 2010. New endotracheal tubes designed to prevent ventilator-associated pneumonia: do they make a difference? Respiratory Care, 55(8), pp. 1046–1055. PMid:20667152
Díaz, L.A., Llauradó, M., Rello, J. & Restrepo, M.I., 2010. Non-pharmacological prevention of ventilator-associated pneumonia. Archivos de Bronconeumologia, 46(4), pp. 188–195. http://dx.doi.org/10.1016/S1579-2129(10)70047-1
Dolar, M. & Jaklič, A., 2010. Subglotična aspiracija in preprečevanje. In: Zbornik predavanj strokovnega srečanja. 19. simpozij intenzivne medicine in 16. seminar intenzivne medicine za medicinske sestre in zdravstvene tehnike,Bled 13. in 14. maj 2010. Ljubljana: Slovensko združenje za intenzivno medicino, pp. 155–157.
Feider, L.L., Mitchell, P. & Bridges, E., 2010. Oral care practices for orally intubated critically ill adults. American Journal of Critical Care, 19(2), pp. 175–183. http://dx.doi.org/10.4037/ajcc2010816 PMid:20194614
Fernandez, J.F., Levine, S.M. & Restrepo, M.I., 2012. Technologic advances in endotracheal tubes for prevention of ventilator-associated pneumonia. Chest, 142(1), pp. 231–238. http://dx.doi.org/10.1378/chest.11-2420 PMid:22796845; PMCid:PMC3418858
Garcia, R., Jendresky, L., Colbert, L., Bailey, A., Zaman, M. & Majumder, M., 2009. Reducing ventilator-associated pneumonia through advanced oral-dental care: a 48-month study. American Journal of Critical Care, 18(6), pp. 523–534. http://dx.doi.org/10.4037/ajcc2009311 PMid:19635805
Jaillette, E., Zerimech, F., De Jonckheere, J., Makris, D., Balduyck, M., Durocher, A., et al., 2013. Efficiency of a pneumatic device in controlling cuff pressure of polyurethane-cuffed tracheal tubes: a randomized controlled study. Bio Med Central Anesthesiology, 13(1), p. 50. http://dx.doi.org/10.1186/1471-2253-13-50 PMid:24369057; PMCid:PMC3877974
Jain, M.K. & Tripathi, C.B., 2011. Endotracheal tube cuff pressure monitoring during neurosurgery – manual vs. automatic method. Journal of Anaesthesiology Clinical Pharmacology, 27(3), pp. 358–361. http://dx.doi.org/10.4103/0970-9185.83682 PMid:21897508; PMCid:PMC3161462
Jaklič, A., 2011. Preprečevanje VAP – aktivnosti zdravstvene nege. In: Peternelj, K, ed. Mehanska ventilacija: zbornik prispevkov z recenzijo. Ljubljana 24. november 2011. Ljubljana: Zbornica zdravstvene in babiške nege Slovenije – Zveza strokovnih društev medicinskih sester, babic in zdravstvenih tehnikov Slovenije, Sekcija medicinskih sester in zdravstvenih tehnikov z anesteziologiji, intenzivni terapiji in transfuziologiji, pp. 64–73.
Jordan, P., van Rooyen, D. & Venter, D., 2012. Endotracheal tube cuff pressure management in adult critical care units. South African Journal of Surgery, 28(1), pp. 13–16. http://dx.doi.org/10.7196/sajcc.129
Kodila, V., 2008. Osnovni vodnik po kirurški enoti intenzivnega zdravljenja. Ljubljana: Univerzitetni klinični center Ljubljana, Kirurška klinika, Klinični oddelek za anesteziologijo in intenzivno terapijo operativnih strok, pp. 82–102.
Madjdpour, C., Mauch, J., Dave, M.H., Spielmann, N. & Weiss, M., 2012. Comparison of air-sealing characteristics of tapered- vs. cylindrical-shaped high-volume, low-pressure tube cuffs. Acta Anaesthesiologica Scandinavica, 56(2), pp. 230–235. http://dx.doi.org/10.1111/j.1399-6576.2011.02542.x PMid:22091784
Mahmoodpoor, A., Peyrovi-far, A., Hamishehkar, H., Bakhtyiari, Z., Mirinezhad, M.M., Hamidi, M., et al., 2013. Comparison of prophylactic effects of polyurethane cylindrical or tapered cuff and polyvinyl chloride cuff endotracheal tubes on ventilator-associated pneumonia. Acta Medica Iranica, 51(7), pp. 461–466. PMid:23945890
Mažič, M., 2011. Nadzor umetno ventiliranega pacienta. In: Posavec, A, ed. Oskrba dihalne poti in umetna ventilacija v predbolnišničnem okolju: zbornik predavanj. Maribor – Pekre 21. oktober 2011. Ljubljana: Zbornica zdravstvene in babiške nege Slovenije – Zveza strokovnih društev medicinskih sester in zdravstvenih tehnikov Slovenije, Sekcija reševalcev v zdravstvu, pp. 89–105.
Miller, M.A., Arndt, J.L., Konkle, M.A., Chenoweth, C.E., Iwashyna, T.J., Flaherty, K.R., et al., 2011. A polyurethane cuffed endotracheal tube (PUC-ETT) is associated with decreased rates of ventilator-associated pneumonia. Journal of Critical Care, 26(3), pp. 280–286. http://dx.doi.org/10.1016/j.jcrc.2010.05.035 PMid:20655698; PMCid:PMC4009728
Mol, D.A., De Villiers Gdu, T., Claassen, A.J. & Joubert, G., 2004. Use and care of an endotracheal/tracheostomy tube cuff – are intensive care unit staff adequately informed. South African Journal of Surgery, 42(1), pp. 14–16. PMid:15181709
Motoyama, A., Asai, S., Konami, H., Matsumoto, Y., Misumi, T. & Imanaka, H., 2014. Changes in endotracheal tube cuff pressure in mechanically ventilated adult patients. Journal of Intensive Care, 2(1), p. 7. http://dx.doi.org/10.1186/2052-0492-2-7 PMid:25520824; PMCid:PMC4267542
Moule, P. & Goodman, M., 2009. Nursing research. London: Sage Publications, pp. 249, 250.
Munro, C.L., Grap, M.J., Jones, D.J., McClish, D.K. & Sessler, C.N., 2009. Chlorhexidine, toothbrushing, and preventing ventilator-associated pneumonia in critically ill adults. American Journal of Critical Care, 18(5), pp. 428–437. http://dx.doi.org/10.4037/ajcc2009792 PMid:19723863; PMCid:PMC3722581
Muzlovič, I., 2007. Pljučnica ob umetnem predihavanju. In: Muzlovič, I., et al. eds. Respiracijski center: 50 let prvega slovenskega oddelka intenzivne terapije Klinike za infekcijske bolezni in vročinska stanja: strokovno srečanje z mednarodno udeležbo: zbornik predavanj. Ljubljana 11. in 12. maj 2007. Ljubljana: Klinika za infekcijske bolezni in vročinska stanja, Klinični center: Združenje za infektologijo pri Slovenskem zdravniškem društvu, pp. 161–172.
Muzlovič, I., 2009. Pljučnica pri mehanskem predihavanju. In: Šola intenzivne medicine 2009, 1. letnik. Novo mesto: Slovensko združenje za intenzivno medicino, pp. 133–144.
Papla, B., Dyduch, G., Frasik, W. & Olechnowicz, H., 2003. Post-intubation tracheal stenosis – morphological-clinical investigations. Polish Journal of Pathology, 54(4), pp. 261–266. PMid:14998295
Poelaert, J., Depuydt, P., De Wolf, A., Van de Velde, S., Herck, I. & Blot, S., 2008. Polyurethane cuff endotracheal tubes to prevent early postoperative pneumonia after cardiac surgery: a pilot study. The Journal of Thoracic and Cardiovascular Surgery, 135(4), pp. 771–776. http://dx.doi.org/10.1016/j.jtcvs.2007.08.052 PMid:18374755
Prestor, L., 2006. Pravilno napihovanje balončka pri intubiranem bolniku. In: Kadivec, S., ed. Obravnava pljučnega bolnika v bolnišnici: zbornik predavanj za medicinske sestre in zdravstvene tehnike, 5. golniški simpozij, Golnik, Brdo pri Kranju 13. in 14. oktober 2006. Golnik: Bolnišnica Golnik, Klinični oddelek za pljučne bolezni in alergijo, pp. 127–133.
Rose, L. & Redl, L., 2008. Survey of cuff management practices in intensive care units in Australia and New Zeland. American Journal of Critical Care, 17(5), pp. 428–435. PMid:18775998
Rosenblatt, W.H., 2006. Airway management. In: Barash, P.G., Cullen, B.F. & Stoelting, R.K. eds. Clinical Anesthesia. 5th ed. Philadelphia: Lyppincott, Williams & Wilkins, pp. 596–643.
Rouze, A., 2013. Continous control of tracheal cuff pressure for the prevention of ventilator-associated pneumonia in critically ill patients:where is the evidence. Current Opinion in Critical Care, 19(5), pp. 440–447. http://dx.doi.org/10.1097/MCC.0b013e3283636b71 PMid:23856895
Sengupta, P., Sessler, D.I., Maglinger, P., Wells, S., Vogt, A., Durrani, J., et al., 2004. Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure. Bio Med Central Anesthesiology, 4(1), p. 8. http://dx.doi.org/10.1186/1471-2288-4-8 PMid:15090073; PMCid:PMC404462
Shander, A., 2011. Endotracheal tube cuff design and the impact on aspirations. Essential practices in respiratory care. Available at: http://www.essential-practices.org/ep_2.pdf [10. 7. 2014].
Skela-Savič, B., 2009. Zdravstvena nega in raziskovanje: nekateri vplivni dejavniki za razvoj zdravstvenene nege kot znanstvene discipline v Sloveniji. Obzornik zdravstvene nege, 43(3), pp. 209–222.
Sole, M.L., Penoyer, D.A., Su, X.G., Jimenez, E., Kalita, S.J., Poalillo, E., et al., 2009. Assessment of endotracheal cuff pressure by continuous monitoring: a pilot study. American Journal of Critical Care, 18(2), pp. 133–143. http://dx.doi.org/10.4037/ajcc2009441 PMid:19255103
Sole, M.L., Su, X., Talbert, S., Penoyer, D.A., Kalita, S., Jimenez, E., et al., 2011. Evaluation of an intervention to maintain endotracheal tube cuff pressure within therapeutic range. American Journal of Critical Care, 20(2), pp. 109–117. http://dx.doi.org/10.4037/ajcc2011661 PMid:21362715; PMCid:PMC3506174
Spiegel, J.A., 2010. Endotracheal tube cuffs: design and function. Anesthesiology News, 36(8), pp. 51–55.
St. John, R.E., 2006. Airway and ventilatory management. In: Chulay, M. & Burns, S.M. eds. AACN essentials of critical care nursing. New York: McGraw-Hill, Medical Publishing Division, pp. 111–144.
Stewart, S.L., Secrest, J.A., Norwood, B.R. & Zachary, R. A., 2003. Comparison of endotraceal tube cuff pressures using estimation techniques and direct intracuff measurement. American Association of Nurse Anestethists Journal, 71(6), pp. 443–447.
Urden, L.D., Stacy, K.M. & Lough, M.E., 2006. Thelan's critical care nursing: diagnosis and management. 5th ed. St. Louis: Mosby, p. 675.
Valencia, M., Ferrer, M., Farre, R., Navajas, D., Badia, J.R., Nicolas, J.M. et al., 2007. Automatic control of tracheal tube cuff pressure in ventilated patients in semirecumbent position: a randomized trial. Critical Care Medicine, 35(6), pp. 1543–1549. http://dx.doi.org/10.1097/01.CCM.0000266686.95843.7D PMid:17452937
Videčnik Zorman, J., 2007. Preprečevanje pljučnic, povezanih z mehanskim predihavanjem. In: Muzlovič, I. et al. eds. Respiracijski center: 50 let prvega slovenskega oddelka intenzivne terapije Klinike za infekcijske bolezni in vročinska stanja: strokovno srečanje z mednarodno udeležbo: zbornik predavanj. Ljubljana 11. in 12. maj 2007. Ljubljana: Klinika za infekcijske bolezni in vročinska stanja, Klinični center: Združenje za infektologijo pri Slovenskem zdravniškem društvu, pp. 233–240.
Vincent, J.L., de Souza Barros, D. & Cianferoni, S., 2010. Diagnosis, management and prevention of ventilator-associated pneumonia. Drugs, 70(15), pp. 1927–1944. http://dx.doi.org/10.2165/11538080-000000000-00000 PMid:20883051
Vyas, D., Inweregbu, K. & Pittard, A., 2002. Measurement of tracheal tube cuff pressure in critical care. Anaesthesia, 57(3), pp. 275–277. http://dx.doi.org/10.1046/j.1365-2044.2002.2404_3.x PMid:11892637
Young, P.J., Pakeerathan, S., Blunt, M.C. & Subramanya, S., 2006. A low-volume, low-pressure tracheal tube cuff reduces pulmonary aspiration. Critical Care Medicine, 34(3), pp. 632–639. http://dx.doi.org/10.1097/01.CCM.0000201406.57821.5B PMid:16505646
Zanella, A., Scaravilli, V., Isgrò, S., Milan, M., Cressoni, M., Patroniti, N., et al., 2011. Fluid leakage across tracheal tube cuff, effect of different cuff material, shape, and positive expiratory pressure: a bench-top study. Intensive Care Medicine, 37(2), pp. 343–347. http://dx.doi.org/10.1007/s00134-010-2106-z PMid:21152894
Zias, N., Chroneou, A., Tabba, M.K., Gonzalez, A.V., Gray, A.W., Lamb, C.R., et al., 2008. Post tracheostomy and post intubation tracheal stenosis: report of 31 cases and review of the literature. BMC Pulmonary Medicine, 8, p. 18. http://dx.doi.org/10.1186/1471-2466-8-18 PMid:18803874; PMCid:PMC2556644
Downloads
Published
How to Cite
Issue
Section
License
As the author undersigned hereby, I transfer, assign, or otherwise convey the following authorship rights as comprised in the Copyright and Related Rights Act (CRRA) to the Slovenian Nursing Review, Ob železnici 30A, 1000 Ljubljana: the right of reproduction - the exclusive right to fix the work in a material medium or in another copy directly or indirectly, temporarily or permanently, by any means and in any digital form, in whole or in part (CRRA, Article 23); the right of distribution (CRRA, Article 24); the right of making a work available and accessible through the internet (CRRA, Article 32a); the right of transformation, especially the exclusive right to translate a pre-existing work (CRRA, Article 33). The transfer of author rights applies to the article in its entirety, including pictorial and/or graphic works and possible supplements. The transfer of rights is exclusive and unlimited in duration or territory.
