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Continuous Telemetric In Utero Tracheal Pressure Measurements in Fetal Lambs
Published on: December 22, 2023
Intermittent versus continuous control of tracheal cuff pressure in patients undergoing mechanical ventilation:
Qin Chen1, Xuemei Yu1, Yidan Chen1
1Department of Neurosurgery, Suzhou Kowloon Hospital, Shanghai Jiao Tong University, School of Medicine, Suzhou, China.
Aims And Objectives:
To evaluate the effects and safety of intermittent versus continuous control of cuff pressure in patients with mechanical ventilation.
Background:
Tracheal cuff pressure management is vital to the prognosis of patients with mechanical ventilation.
Design:
A meta-analysis.
Methods:
This meta-analysis was conducted and reported according to the PRISMA checklist. We searched Pubmed, Embase, The Cochrane Library, BMJ Best Practice, Web of Science, ProQuest Dissertations, as well as the Chinese Biomedical Literature Database, Wanfang, and China national knowledge infrastructure databases up to 5 August 2022 for randomised controlled trials (RCTs) on the intermittent versus continuous control of cuff pressure. Review Manager 5.3 software was used for relevant data analysis.
Results:
A total of 18 RCTs involving 1998 patients with mechanical ventilation were included. The synthesised outcomes indicated that continuous control of cuff pressure is beneficial to reduce the incidence of ventilator-associated pneumonia (VAP) [RR = 0.41, 95%CI (0.35, 0.49)], aspiration [RR = 0.36, 95%CI (0.21, 0.63)], duration of mechanical ventilation [MD = -3.23, 95%CI (-4.66, -1.79)], length of ICU stay [MD = -4.12, 95%CI (-5.40, -2.83)], and increase the volume of subglottic drainage [MD = 18.54, 95%CI (16.50, 20.58)]. There was no significant difference in the mortality between two groups [RR = 1.01, 95%CI (0.84, 1.21)]. Egger regression analyses showed that there were no obvious publication biases in the synthesised results (all p > .05).
Conclusions:
Existing evidence shows that compared with intermittent monitoring of cuff pressure, continuous monitoring of cuff pressure can reduce the occurrence of aspiration and VAP, shorten the patient's duration of mechanical ventilation and length of ICU stay.
Relevance To Clinical Practice:
Continuous monitoring of cuff pressure is more beneficial and should be promoted in clinical nursing care of patients undergoing mechanical ventilation.
Insights
Continuous monitoring of tracheal cuff pressure in mechanically ventilated patients significantly reduces ventilator-associated pneumonia and aspiration. This method also shortens ventilation duration and ICU stay, improving patient outcomes.
Area of Science:
- Critical Care Medicine
- Respiratory Therapy
- Clinical Nursing
Background:
- Effective tracheal cuff pressure management is crucial for patients on mechanical ventilation.
- Optimizing cuff pressure minimizes risks such as aspiration and ventilator-associated pneumonia (VAP).
Approach:
- A comprehensive meta-analysis of 18 randomized controlled trials (RCTs) involving 1998 patients.
- Systematic literature search across major databases (PubMed, Embase, Web of Science, etc.) up to August 2022.
- Data synthesis using Review Manager 5.3, with publication bias assessed via Egger regression.
Key Points:
- Continuous cuff pressure control reduced VAP incidence (RR 0.41) and aspiration (RR 0.36).
- Continuous monitoring shortened mechanical ventilation duration (MD -3.23 days) and ICU length of stay (MD -4.12 days).
- Increased subglottic drainage volume (MD 18.54 mL) observed with continuous control; no significant difference in mortality.
Conclusions:
- Continuous tracheal cuff pressure monitoring offers significant benefits over intermittent methods.
- Promoting continuous monitoring in clinical practice can enhance patient care and reduce complications.
- Evidence supports continuous cuff pressure management for improved patient prognosis during mechanical ventilation.
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