Continuous control of tracheal cuff pressure for VAP prevention: a collaborative meta-analysis of individual participant data.
BACKGROUND
Underinflation of tracheal cuff is a risk factor for microaspiration of contaminated secretions and subsequent ventilator-associated pneumonia (VAP). The aim of this collaborative meta-analysis of individual participant data is to determine the impact of continuous control of P cuff on the incidence of VAP.


METHODS
Studies were identified by searching PubMed and references of relevant articles. Data from 3 prospective controlled trials (two randomized and one quasi-randomized), which evaluated the impact of continuous control of P cuff on the incidence of VAP, were obtained and pooled together. Three different devices were used to continuously control P cuff. VAP was diagnosed using clinical, radiologic, and quantitative microbiological criteria. The impact of continuous control of P cuff on VAP was assessed by Cox regression analysis, stratified on trial.


RESULTS
263 (48.4 %) patients received continuous control of P cuff, and 280 (51.5 %) patients received routine control of P cuff using a manometer. 36 (13.6 %) VAP were diagnosed in continuous control group, and 72 (25.7 %) in routine care group (HR 0.47, 95 % CI 0.31-0.71, p < 0.001). However, heterogeneity was apparent in continuous control effect size across trials (I (2) = 58 %, p = 0.085). The number of patients needed to treat to prevent one VAP episode was 8. No significant impact of continuous control of P cuff was found on duration of mechanical ventilation, ICU length of stay, or mortality.


CONCLUSION
Continuous control of P cuff might be beneficial in reducing the risk for VAP. However, no significant impact of continuous control of P cuff was found on duration of mechanical ventilation, ICU length of stay, or mortality.
['Nseir|Saad|S|', 'Lorente|Leonardo|L|', 'Ferrer|Miquel|M|', 'Rouzé|Anahita|A|', 'Gonzalez|Oswaldo|O|', 'Bassi|Gianluigi Li|GL|', 'Duhamel|Alain|A|', 'Torres|Antoni|A|']
Cuff pressure Meta-analysis Microaspiration Pneumonia Mechanical ventilation Critical care