• Saad Nseir, Farid Zerimech, Clément Fournier, Rémy Lubret, Philippe Ramon, Alain Durocher, and Malika Balduyck.
• Intensive Care Unit, Biochemistry Division, Pathology and Biology Center, University Hospital of Lille, France. s-nseir@chru-lille.fr
• Am. J. Respir. Crit. Care Med.. 2011 Nov 1;184(9):1041-7.

RationaleUnderinflation of the tracheal cuff frequently occurs in critically ill patients and represents a risk factor for microaspiration of contaminated oropharyngeal secretions and gastric contents that plays a major role in the pathogenesis of ventilator-associated pneumonia (VAP).ObjectivesTo determine the impact of continuous control of tracheal cuff pressure (P(cuff)) on microaspiration of gastric contents.MethodsProspective randomized controlled trial performed in a single medical intensive care unit. A total of 122 patients expected to receive mechanical ventilation for at least 48 hours through a tracheal tube were randomized to receive continuous control of P(cuff) using a pneumatic device (intervention group, n = 61) or routine care of P(cuff) (control group, n = 61).Measurements And Main ResultsThe primary outcome was microaspiration of gastric contents as defined by the presence of pepsin at a significant level in tracheal secretions collected during the 48 hours after randomization. Secondary outcomes included incidence of VAP, tracheobronchial bacterial concentration, and tracheal ischemic lesions. The pneumatic device was efficient in controlling P(cuff). Pepsin was measured in 1,205 tracheal aspirates. Percentage of patients with abundant microaspiration (18 vs. 46%; P = 0.002; OR [95% confidence interval], 0.25 [0.11-0.59]), bacterial concentration in tracheal aspirates (mean ± SD 1.6 ± 2.4 vs. 3.1 ± 3.7 log(10) cfu/ml, P = 0.014), and VAP rate (9.8 vs. 26.2%; P = 0.032; 0.30 [0.11-0.84]) were significantly lower in the intervention group compared with the control group. However, no significant difference was found in tracheal ischemia score between the two groups.ConclusionsContinuous control of P(cuff) is associated with significantly decreased microaspiration of gastric contents in critically ill patients.

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