• Saad Nseir, Leonardo Lorente, Miquel Ferrer, Anahita Rouzé, Oswaldo Gonzalez, BassiGianluigi LiGLRespiratory Intensive and Intermediate Care Unit, Department of Pneumology, Hospital Clinic, Institute of Thorax, Barcelona, Spain. glibassi@clinic.ub.es., Alain Duhamel, and Antoni Torres.
• CHU Lille, Centre de Réanimation, 59000, Lille, France. s-nseir@chru-lille.fr.
• Ann Intensive Care. 2015 Dec 1; 5 (1): 43.

BackgroundUnderinflation of tracheal cuff is a risk factor for microaspiration of contaminated secretions and subsequent ventilator-associated pneumonia (VAP). The aim of this collaborative meta-analysis of individual participant data is to determine the impact of continuous control of P cuff on the incidence of VAP.MethodsStudies were identified by searching PubMed and references of relevant articles. Data from 3 prospective controlled trials (two randomized and one quasi-randomized), which evaluated the impact of continuous control of P cuff on the incidence of VAP, were obtained and pooled together. Three different devices were used to continuously control P cuff. VAP was diagnosed using clinical, radiologic, and quantitative microbiological criteria. The impact of continuous control of P cuff on VAP was assessed by Cox regression analysis, stratified on trial.Results263 (48.4 %) patients received continuous control of P cuff, and 280 (51.5 %) patients received routine control of P cuff using a manometer. 36 (13.6 %) VAP were diagnosed in continuous control group, and 72 (25.7 %) in routine care group (HR 0.47, 95 % CI 0.31-0.71, p < 0.001). However, heterogeneity was apparent in continuous control effect size across trials (I (2) = 58 %, p = 0.085). The number of patients needed to treat to prevent one VAP episode was 8. No significant impact of continuous control of P cuff was found on duration of mechanical ventilation, ICU length of stay, or mortality.ConclusionContinuous control of P cuff might be beneficial in reducing the risk for VAP. However, no significant impact of continuous control of P cuff was found on duration of mechanical ventilation, ICU length of stay, or mortality.

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