Impact of Monitoring Endotracheal Cuff Pressure on Endoscopic Laryngo-Tracheal Injury: A Randomized Pilot Study

Abstract

Aims: Underinflation (<20 cmH2O) and overinflation (>30 cmH2O) of tracheal cuff are independent factors of microaspiration and tracheal ischemic lesions respectively. The aim of this study was to evaluate the impact of discontinuous monitoring of endotracheal cuff pressure on the incidence of endoscopic laryngotracheal injury and to analyze factors associated with the development of these lesions. Study Design: Prospective and randomized study. Place and Duration of Study: Medical Intensive care unit at Taher Sfar Hospital in Mahdia, between December 2010 and April 2012. Methodology: All patients admitted to our intensive care unit (ICU) and requiring invasive mechanical ventilation for more than 48 hours were randomly assigned to have or not a discontinuous cuff pressure monitoring. The primary outcome was the incidence of endoscopic laryngotracheal injury during ICU stay. Secondary outcomes were the incidence of endoscopic laryngotracheal injury at day-90, ventilator-associated pneumonia, the length of stay, the duration of mechanical ventilation and mortality. Results: Ninety-five patients (49 in the monitored group and 46 in the control group) aged 59 ± 20 years, were included in the study. The incidence of endoscopic laryngotracheal injury was 42% with no significant difference between study groups. The proportion of patients with tracheal granulation was significantly lower in the monitored group: 4% vs 24% (p= 0.0049). Secondary outcomes were similar between the two groups. ICU admission for intoxication was the only independent factor associated with the occurrence of endoscopic laryngotracheal injury (OR 6.779, CI 95% (1.121- 41,008); p= 0.037). Conclusions: Discontinuous monitoring of cuff pressure did not reduce the overall incidence of endoscopic laryngotracheal injury but only the incidence of tracheal granuloma. These results recommend the routine survey of cuff pressure in ICU.