How to avoid microaspiration? A key element for the prevention of ventilator-associated pneumonia in intubated ICU patients

Blot, Stijn I., Poelaert, Jan and Kollef, Marin (2014) How to avoid microaspiration? A key element for the prevention of ventilator-associated pneumonia in intubated ICU patients. BMC Infectious Diseases, 14 119: 1-6. doi:10.1186/1471-2334-14-119

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Author Blot, Stijn I.
Poelaert, Jan
Kollef, Marin
Title How to avoid microaspiration? A key element for the prevention of ventilator-associated pneumonia in intubated ICU patients
Journal name BMC Infectious Diseases   Check publisher's open access policy
ISSN 1471-2334
Publication date 2014-11-28
Year available 2014
Sub-type Article (original research)
DOI 10.1186/1471-2334-14-119
Open Access Status DOI
Volume 14
Issue 119
Start page 1
End page 6
Total pages 6
Place of publication London, United Kingdom
Publisher BioMed Central
Language eng
Formatted abstract
Microaspiration of subglottic secretions through channels formed by folds in high volume-low pressure poly-vinyl chloride cuffs of endotracheal tubes is considered a significant pathogenic mechanism of ventilator-associated pneumonia (VAP). Therefore a series of prevention measures target the avoidance of microaspiration. However, although some of these can minimize microaspiration, benefits in terms of VAP prevention are not always obvious. Polyurethane-cuffed endotracheal tubes successfully reduce microaspiration but high quality data demonstrating VAP rate reduction are lacking. An analogous conclusion can be made regarding taper-shaped cuffs compared with classic barrel-shaped cuffs. More clinical data regarding these endotracheal tube designs are needed to demonstrate clinical value in addition to in vitro-based evidence. The clinical usefulness of endotracheal tubes developed for subglottic secretions drainage is established in multiple studies and confirmed by meta-analysis. Any change in cuff design will fail to prevent microaspiration if the cuff is insufficiently inflated. At least one well-designed trial demonstrated that continuous cuff pressure monitoring and control decrease the risk of VAP. Gel lubrication of the cuff prior to intubation temporarily hampers microaspiration through sludging the channels formed by folds in high volume-low pressure cuffs. As the beneficial effect of gel lubrication is temporarily, its potential to reduce VAP risk is probably nonsignificant. A minimum positive end-expiratory pressure of at least 5 cmH2O can be recommended as it reduces the risk of microaspiration in vitro and in vivo. One randomized controlled study demonstrated a reduced risk of VAP in patients ventilated with PEEP (5–8 cmH2O). Regarding head-of-bed elevation, it can be recommended to avoid supine positioning. Whether a 45° head-of-bed elevation is to be preferred above 25-30° head-of-bed elevation remains unproven. Finally, the routine monitoring of gastric residual volumes in mechanically ventilated patients receiving enteral nutrition cannot be recommended.
Keyword Ventilator-associated pneumonia
Pneumonia
Micro-aspiration
Prevention
Infection
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
Official Audit
School of Medicine Publications
 
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