#2 Low-Volume, Low-Pressure Tracheal Tube Cuff To Reduce Ventilator-Associated Pneumonia

Overview

Patients in an intensive care unit (ICU) are not only at risk of dying from their primary illness but also from
pneumonia that they contract in the ICU. Ventilator-associated pneumonia (VAP) remains one of the most lethal
and frequently occurring infections among critically ill patients who must be mechanically ventilated (along with
requisite endotracheal intubation) for more than 48 hours. 

Not only the leading cause of hospital-acquired mortality in the ICU, this deadly pneumonia also extends ICU stay by at least six days, and can easily result in more than $40,000 in additional hospital costs.

“VAP, which often develops after an endotracheal tube is put in place, is one of the most serious and costly
hospital-acquired infections,” says Michael Roizen, MD, Chief Wellness Officer, Cleveland Clinic.

“In the United States, VAP is estimated to result in $1.5 billion in excess expenditure and almost 2 million additional hospital days each year.”

When critically ill patients are put on a ventilator, the cough reflex is suppressed and they are immediately at risk.

Most people will typically develop VAP after a traditional tracheal tube is used due to leakage of fluid that has pooled at the back of the throat, regurgitation, and aspiration of these secretions into the lungs. Removal of these secretions is extremely challenging for critical care nurses, and this allows micro-organisms to enter the normally sterile lower respiratory tract and produce a substantial infection.

More than 300,000 cases of hospital-acquired VAP occur annually in the United States. It’s estimated that upwards of 27% of intubated patients will develop VAP, and those who do are at a significantly higher risk of dying, especially during the first five days of ventilation.

Avoidance of mechanical ventilation is obviously the best way to prevent VAP, but that is not always possible for
all patients. However, for those who must be intubated, there is now an effective way to reduce serious pulmonary problems and save lives in the ICU. A new low-volume, low-pressure endotracheal tube cuff with a special suction setup that provides effective airway seals at low pressure and allows all secretions to drain from the subglottic space just above the tube cuff, has recently been approved for use in the United Kingdom. Approval from the U.S. Food and Drug Administration is expected later this year.

Current models of tracheostomy tubes have an inflatable cuff that is designed to seal against a patient’s trachea when they are ventilated and this should prevent fluids from entering into the lungs and causing infection. However, these cuff devices have only provided a partial seal, and secretions eventually do pass into the lungs.

This new device dramatically reduces the risk of VAP by providing continuous effective airway seals at low mucosal pressures. It allows secretion drainage from the subglottic space, and allows saline irrigation of the subglottis and upper airway. The device is so effective that it can be left in place for up to 30 days.

“The most exciting aspect relating to the system is that because there is complete prevention of aspiration, the effect on VAP is significant,” says Dr. Roizen. This translates to an elimination of bacterial colonization of the lungs and therefore no late onset VAP.

Where Are They Now

These continuous flow pumps are the new generation of ventricular assist devices, and have been proven to be smaller, quieter and easier to implant than the previous pulsatile versions. Compared to pulsatile pumps, continuous flow pumps have a longer lifetime, making them the more reliable and durable option. However, there have been some complications associated with continuous flow devices, and despite being more popular than its pulsatile counterpart, there is some conflicting evidence as to which is the best option. In 2016 there is still a need of more clinical trials to address the utility, optimal device programming and timing of ICD implantation in continuous-flow LVAD patients as no substantial evidence as to which is the best option. These continuous flow pumps are the new generation of ventricular assist devices, and have been proven to be smaller, quieter and easier to implant than the previous pulsatile versions. Compared to pulsatile pumps, continuous flow pumps have a longer lifetime, making them the more reliable and durable option. However, there have been some complications associated with continuous flow devices, and despite being more popular than its pulsatile counterpart, there is some conflicting evidence as to which is the best option. In 2016 there is still a need of more clinical trials to address the utility, optimal device programming and timing of ICD implantation in continuous-flow LVAD patients as no substantial evidence as to which is the best option.

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