MONITORING OF ENDOTRACHEAL TUBE CUFF PRESSURE IN OCCURRENCE OF VENTILATOR ASSOCIATED PNEUMONIA IN NEURO-CRITICALLY ILL PATIENTS

Abstract

Neurocritically ill patients are highly susceptible to respiratory complications due to impaired consciousness, compromised airway reflexes, and neuromuscular dysfunction, predisposing them to oropharyngeal secretion aspiration and pneumonia. Ventilator-associated pneumonia (VAP), defined as pneumonia developing after 48 hours of mechanical ventilation, is a significant healthcare-associated infection in ICUs, associated with increased morbidity, prolonged ventilation and hospitalization, and a mortality rate ranging from 10% to over 50%. VAP pathogenesis involves micro-aspiration of contaminated secretions above the endotracheal tube (ETT) cuff, facilitated by disrupted airway defenses and biofilm formation. Maintaining ETT cuff pressure between 20 and 30 cm H2O, as recommended by organizations like ATS and IDSA, is crucial to prevent leakage. Despite these guidelines, there is no universally accepted standard for ETT cuff pressure monitoring frequency to maintain this accepted range, highlighting the need to investigate the relationship between monitoring practices and VAP incidence in this vulnerable population.AimThe aim of this study was to compare infrequent endotracheal tube cuff pressure monitoring (immediately after intubation, every 8 hours, and when clinically indicated) with more frequent endotracheal tube cuff pressure monitoring (immediately after intubation, every 4 hours, any intervention with the patient and when clinically indicated) on the incidence of ventilator associated pneumonia in neuro-critically ill patients.