Effectiveness of Continuous Automatic Endotracheal Cuff Pressure Monitoring in Preventing Ventilator-Associated Pneumonia in the Pediatric Intensive Care Unit: A Randomized Controlled Trial.

IF 9.8 1区医学 Q1 CRITICAL CARE MEDICINE

Chest Pub Date : 2026-10-10 DOI:10.1016/j.chest.2026.10.003

Ayşe Aşık, Muhterem Duyu, Saime Hacer Özdemir Dağhan, Pelin Pehlivan, Burçin Türkmen, Nergiz Alçınkaya Sevinç, Yasemin Tüfekçi, Büşra Özyıldırım, Selin Yıldız Sametoğlu, Yonca Bulut

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引用次数: 0

Abstract

Background: Ventilator-associated pneumonia (VAP) is a major healthcare-associated infection in critically ill children, primarily driven by microaspiration around the endotracheal tube cuff.

Research question: Does continuous automatic cuff pressure monitoring (CACPM) reduce the incidence of VAP compared to intermittent manual cuff pressure monitoring (IMCPM) in critically ill pediatric patients requiring mechanical ventilation?

Study design and methods: In this open-label, randomized controlled superiority trial, pediatric patients requiring mechanical ventilation for ≥48 hours were randomly assigned (1:1) to either CACPM or IMCPM. The target cuff pressure was strictly maintained at 20-25 cmH₂O. The primary outcome was the proportion of patients developing VAP within 28 days following intubation, evaluated in the intention to treat population. Secondary outcomes included time to VAP diagnosis and target pressure compliance. Statistical approaches included Kaplan-Meier survival analysis and multivariable Cox proportional hazard regression.

Results: Among 241 randomized patients, ITT analysis showed lower VAP with CACPM than IMCPM (13.3% vs 24.0%; risk difference, -10.6 percentage points; 95% CI, -20.3 to -0.8; P=0.034), with similar PP findings (15.0% vs 26.6%; P=0.044). ITT incidence density was 15.7 vs 27.1 per 1,000 ventilator-days (IRR, 1.73; 95% CI, 0.94-3.18; P=0.080). Unadjusted time-to-VAP was nonsignificant (HR, 1.80; 95% CI, 0.976-3.321; P=0.060), whereas adjusted Cox analysis narrowly indicated a higher VAP hazard with IMCPM (HR, 1.90; 95% CI, 1.024-3.510; P=0.042). Target-pressure compliance was higher with CACPM (P<0.001).

Interpretation: CACPM significantly reduces the proportion of critically ill pediatric patients developing VAP compared with IMCPM. This preventive effect appears directly linked to improved target pressure compliance, suggesting that automated regulation could be a valuable addition to pediatric VAP prevention strategies.

Clinical trial registration: ClinicalTrials.gov, NCT05918172.

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来源期刊

Chest 医学-呼吸系统

CiteScore

13.70

自引率

3.10%

发文量

3369

审稿时长

15 days

期刊介绍： At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.