ABSTRACT: BACKGROUND: This clinical study evaluated the effect of a suctioning maneuver on aspiration past the cuff during mechanical ventilation. METHODS: Patients intubated for less than 48 hours with a PVC-cuffed tracheal tube, under mechanical ventilation with a PEEP >=5 cm H2O and under continuous sedation, were included in the study. At baseline the cuff pressure was set at 30 cm H2O. Then 0.5ml of blue dye diluted with 3 ml of saline was instilled into the subglottic space just above the cuff. Tracheal suctioning was performed using a 16-French suction catheter with a suction pressure of -- 400 mbar. A fiberoptic bronchoscopy was performed before and after the suctioning maneuver, looking for the presence of blue dye in the folds within the cuff wall or in the trachea under the cuff. The sealing of the cuff was defined by the absence of leakage of blue dye either in the cuff wall or in the trachea under the cuff. RESULTS: Twenty-five patients were included. The size of the tracheal tube was 7-mm ID for 5 patients, 7.5-mm ID for 16 patients, and 8-mm ID for four patients. Blue dye was never seen in the trachea under the cuff before suctioning and only in one patient (4%) after the suctioning maneuver. Blue dye was observed in the folds within the cuff wall in 6 of 25 patients before suctioning and 11 of 25 after (p = 0.063). Overall, the incidence of sealing of the cuff was 76% before suctioning and 56% after (p = 0.073). CONCLUSIONS: In patients intubated with a PVC-cuffed tracheal tube and under mechanical ventilation with PEEP >=5 cm H2O and a cuff pressure set at 30 cm H2O, a single tracheal suctioning maneuver did not increase the risk of aspiration in the trachea under the cuff.Trial registrationClinicalTrials.gov, number NCT01170156.
Annals of intensive care. 11/2012; 2(1):45.
ABSTRACT: This study aimed to evaluate an objective measure of cough strength, the peak cough expiratory flow (PCEF), as a predictive criterion of success or failure of extubation.
Patients under mechanical ventilation for more than 24 h who successfully passed the spontaneous breathing trial were included in the study. Just before extubation, PCEF was measured with an electronic flowmeter.
A total of 130 patients were included. The median duration of mechanical ventilation before extubation was 8 days (4-17). Fourteen patients (10.8%) failed extubation. The sole factor significantly associated with extubation failure was the measure of PCEF. The patients who did not cough at order had a higher rate of extubation failure than those who did (P = 0.03). The mean PCEF of patients who failed extubation (36.3 +/- 15 l/min) was significantly lower than the one of patients who succeeded (63.6 +/- 32 l/min) (P < 0.001). The optimal cut-off value of PCEF was 35 l/min. Overall, an inability to cough at order or a PCEF < or =35 l/min predicted extubation failure with a sensitivity of 79% and a specificity of 71%. The risk of extubation failure was 24% for the patients who did not cough at order or with a PCEF < or =35 l/min and 3.5% for those with a PCEF >35 l/min [RR = 6.9 (95% CI, 2-24); P = 0.002].
This study confirmed the interest of measuring the PCEF to predict extubation outcome in patients having successfully passed the spontaneous breathing trial.
European Journal of Intensive Care Medicine 01/2009; 35(6):1090-3. · 5.17 Impact Factor
ABSTRACT: Comatose patients frequently exhibit pulmonary function worsening, especially in cases of pulmonary infection. It appears to have a deleterious effect on neurologic outcome. We therefore conducted a randomized trial to determine whether daily prone positioning would prevent lung worsening in these patients.
Prospective, randomized, controlled study.
Sixteen-bed intensive care unit.
Fifty-one patients who required invasive mechanical ventilation because of coma with Glascow coma scores of 9 or less.
In the prone position (PP) group: prone positioning for 4 h once daily until the patients could get up to sit in an armchair; in the supine position (SP) group: supine positioning.
The primary end point was the incidence of lung worsening defined by an increase in the Lung Injury Score of at least 1 point since the time of randomization. The secondary end point was the incidence of ventilator-associated pneumonia (VAP). A total of 25 patients were randomly assigned to the PP group and 26 patients to the SP group. The characteristics of the patients from the two groups were similar at randomization. The incidence of lung worsening was lower in the PP group (12%) than in the SP group (50%) ( p=0.003). The incidence of VAP was 20% in the PP group and 38.4% in the SP group ( p=0.14). There was no serious complication attributable to prone positioning, however, there was a significant increase of intracranial pressure in the PP.
In a selected population of comatose ventilated patients, daily prone positioning reduced the incidence of lung worsening.
Intensive Care Medicine 06/2002; 28(5):564-9. · 5.40 Impact Factor