%0 Journal Article
%T Impact of a Low-Pressure Polyurethane Adult Endotracheal Tube on the Incidence of Ventilator-Associated Pneumonia: A before and after Concurrence Study
%A John Schweiger
%A Rachel Karlnoski
%A Devanand Mangar
%A Jaya Kolla
%A Gerardo Munoz
%A Peggy Thompson
%A Collin Sprenker
%A Katheryne Downes
%A Enrico M. Camporesi
%J ISRN Critical Care
%D 2013
%R 10.5402/2013/812964
%X Background. Ventilator-associated pneumonia (VAP) is a leading cause of morbidity and mortality in intensive care unit (ICU) patients, encompassing up to 15% of all hospital acquired infections. Our hospital implemented a facility-wide conversion from a low-volume high-pressure polyvinyl cuffed endotracheal tube (PV-cuffed ETT) to a high-volume low-pressure (HVLP) polyurethane-cuffed endotracheal tube (PU-cuffed ETT) in an effort to reduce the incidence of VAP. Methods. We completed an IRB approved, retrospective chart review comparing the number of episodes of VAP 12 months preceding and following the introduction of a new ETT. A diagnosis of VAP was made based upon the guidelines of our institution, consistent with the Center of Disease Control and Prevention definition. Results. The number of patients developing VAP the year after the ETT conversion reduced to 32 (16.3%) from 68 (24.7%) the year before the conversion ( ). The rate of VAP was reduced by 56% per ventilator day after the implementation of the PU-cuffed ETT ( ). No significant differences were observed in length of hospital stay, length of mechanical ventilation, or mortality before or after the conversion. Conclusions. We found that HVLP PU-cuffed ETTs were associated with a statistically significant reduction of VAP in the adult ICUs. 1. Introduction Ventilator-associated pneumonia (VAP) is a healthcare-associated infection that commonly causes morbidity and mortality in mechanically ventilated patients [1]. VAP is associated with an increased duration of mechanical ventilation, crude death rates of 5% to 65% [2¨C5], and increased healthcare costs [1, 6¨C8]. During the past several decades, numerous studies have focused on the role of the endotracheal tube (ETT) in the pathogenesis of VAP. Tracheal intubation impairs the cough reflex, injures the tracheal epithelial surface, facilitates entry of bacteria into the airway by aspiration of subglottic secretions, and allows formation of a bacterial biofilm on the ETT surface. The combination of these factors puts the mechanically ventilated patient at great jeopardy of developing VAP. Because VAP is multifactorial, it is essential to identify changes in practice that may decrease rates. One important preventive strategy for the pathogenesis of VAP is to minimize subglottic secretions and microaspirations. A preventative strategy to avoid the transmission of subglottic secretions into the lower respiratory tract is to prevent channel formation within the folds of the ETT cuff. The properties of the ETT cuff may have an impact on the passage
%U http://www.hindawi.com/journals/isrn.critical.care/2013/812964/