London Deanery, Guy's and St Thomas' NHS Trust, Lambeth Palace Road, London SE1 7EH, UK.
Crit Care. 2011;15(5):310. doi: 10.1186/cc10352. Epub 2011 Sep 29.
Ventilator-associated pneumonia (VAP) is a major healthcare-associated complication with considerable attributable morbidity, mortality and cost. Inherent design flaws in the standard high-volume low-pressure cuffed tracheal tubes form a major part of the pathogenic mechanism causing VAP. The formation of folds in the inflated cuff leads to microaspiration of pooled oropharyngeal secretions into the trachea, and biofilm formation on the inner surface of the tracheal tube helps to maintain bacterial colonization of the lower airways. Improved design of tracheal tubes with new cuff material and shape have reduced the size and number of these folds, which together with the addition of suction ports above the cuff to drain pooled subglottic secretions leads to reduced aspiration of oropharyngeal secretions. Furthermore, coating tracheal tubes with antibacterial agents reduces biofilm formation and the incidence of VAP. In this Viewpoint article we explore the published data supporting the new tracheal tubes and their potential contribution to VAP prevention strategies. We also propose that it may now be against good medical practice to continue to use a 'standard cuffed tube' given what is already known, and the weight of evidence supporting the use of newer tube designs.
呼吸机相关性肺炎（VAP）是一种主要的与医疗保健相关的并发症，具有相当大的发病率、死亡率和费用。标准大容积低压套囊气管导管在设计上存在固有缺陷，这是导致 VAP 的发病机制的主要部分。充气套囊形成的褶皱会导致积聚的咽部分泌物微吸入气管，而气管导管内表面的生物膜形成有助于维持下呼吸道的细菌定植。新型套囊材料和形状的气管导管的改进设计减少了这些褶皱的大小和数量，加上在套囊上方增加抽吸口以排出积聚的声门下分泌物，可减少咽部分泌物的吸入。此外，用抗菌剂涂覆气管导管可减少生物膜形成和 VAP 的发生率。在这篇观点文章中，我们探讨了支持新型气管导管的已发表数据及其对 VAP 预防策略的潜在贡献。我们还提出，鉴于已经了解的情况和支持使用新型导管设计的大量证据，继续使用“标准套囊管”可能不符合良好的医疗实践。
