aIntensive Care Department, R. Salengro Hospital, CHRU bEA 2694, Université Nord de France, Lille, France.
Curr Opin Crit Care. 2013 Oct;19(5):440-7. doi: 10.1097/MCC.0b013e3283636b71.
Ventilator-associated pneumonia (VAP) is a major cause of death, morbidity and costs in ICUs. Several evidence-based clinical interventions have been increasingly described for its prevention. However, continuous control of tracheal cuff pressure (Pcuff) is rarely mentioned in the latest clinical guidelines. This review focuses on the available data about the management of Pcuff in the ICU, including discontinuous and continuous control, and its impact on the prevention of VAP.
Current discontinuous monitoring and adjustment of Pcuff, even well performed, is inaccurate in maintaining Pcuff in the target range. Underinflation (Pcuff<20 cmH2O) of tracheal cuff is an independent risk factor for VAP through microaspiration of contaminated subglottic secretions into the lower respiratory tract. Two main types of devices, electronic and pneumatic, have been developed for the continuous control of Pcuff. Both have shown effectiveness in maintaining Pcuff in recommended range in ICU patients, but only the pneumatic device has provided a reduction in microaspiration and VAP incidence.
Continuous controllers of Pcuff represent effective, easy to use and timesaving devices in today's busy ICU environment. However, further studies are required to determine the impact of continuous control of Pcuff on VAP incidence, patient outcomes, antimicrobial consumption and to compare pneumatic and electronic devices, before generalizing their use in routine practice.
呼吸机相关性肺炎（VAP）是 ICU 患者死亡、发病和费用的主要原因。已越来越多地描述了一些基于证据的临床干预措施来预防 VAP。然而，在最新的临床指南中很少提到持续控制气管套囊压力（Pcuff）。这篇综述重点介绍了 ICU 中套囊压力管理的现有数据，包括间断和连续控制，及其对 VAP 预防的影响。
即使间断监测和调整 Pcuff 得到很好的执行，也不能准确地将 Pcuff 维持在目标范围内。气管套囊充气不足（Pcuff<20cmH2O）通过将受污染的声门下分泌物微吸入下呼吸道，是 VAP 的独立危险因素。已经开发了两种主要类型的设备，电子和气动，用于连续控制 Pcuff。两者都显示出在 ICU 患者中维持 Pcuff 在推荐范围内的有效性，但只有气动设备减少了微吸入和 VAP 的发生率。
在当今繁忙的 ICU 环境中，Pcuff 的连续控制器是有效、易于使用和节省时间的设备。然而，在推广其常规应用之前，还需要进一步研究连续控制 Pcuff 对 VAP 发生率、患者结局、抗菌药物消耗的影响，并比较气动和电子设备。
