Is continuous better than intermittent control of tracheal cuff pressure? A meta-analysis

Abstract

Aim: To compare and evaluate the efficacy and safety of continuous and intermittent control of cuff pressure.

Methods: We performed a comprehensive and systematic meta-analysis of randomized controlled trials (RCTs) assessing the continuous and intermittent control of P_cuff by searching PUBMED, EMBASE and other such databases (from inception to 31 March 2018). Summary odds ratios or mean differences with 95% confidence intervals were calculated using a fixed- or random-effects model.

Measurements and main results: Seven randomised controlled trials with 970 mechanically ventilated patients were included in this study. The continuous control of cuff pressure significantly reduced the incidence of cuff pressure < 20 cm H₂ O (0.03 (OR) (95% CI: 0.01-0.07)), P_cuff > 30 cm H₂ O (0.06 (95% CI: 0.03-0.15)) and VAP (0.39 (95% CI: 0.28-0.55)) when compared with intermittent control of cuff pressure. No significant differences in duration of MV (-1.94 (95% CI: -4.06 to -0.17)), length of ICU stay (-3.88 (95% CI: -9.00 to -1.23)) and mortality (0.99 (95% CI: 0.73-1.35)) were found between the two groups.

Conclusions: Continuous control of cuff pressure offers more benefits in stabilizing the cuff pressure and reducing the incidence of VAP, and more studies are warranted to further evaluate the role of continuous control of cuff pressure.

Relevance to practice: The continuous control of cuff pressure should be conducted whenever possible as it is the most ideal for the prognosis of MV patients.

Keywords: Critical care; Cuff pressure; Mechanical ventilation; Review; Ventilator-associated pneumonia.