Effects of endotracheal tube cuff pressure control on microaspiration of gastric contents

Aim: The aim of this study was to investigate the effect of pilot balloon finger palpation, intermittent and continuous endotracheal tube cuff pressure control on the gastric content microaspiration in deep tracheal aspirates in intensive care patients receiving mechanical ventilator support via endotracheal tube. Methods: The study is a single-blind randomized controlled experimental study. The study was conducted between May - October 2019 in Afyonkarahisar Health Sciences University Health Practice and Research Center Intensive Care Units with the same level of randomization of 135 intensive care unit patients. Patients older than 18 years of age, volunteering by the patient / patient's relatives to participate in the research and who needed mechanical ventilator support via endotracheal tube for at least 48 hours were included in the study. Patients who had nasal endotracheal intubation, patients who were contraindicated in semi-sitting position, had contraindication to enteral nutrition, had been in mechanical ventilator for more than 48 hours, had tracheostomy, gastroesophageal reflux disease, admitted to intensive care for aspiration pneumonia or suspicion were excluded from the sample. A total of 1889 deep tracheal aspirate samples were collected from the patients for 48 post-intubation periods. Data were collected via sociodemographic and clinical features form, patient follow-up form, data collection form for intubation follow-up parameters, vital findings and blood glucose values were recording form. The manometer and smart cuff manager were used to control endotracheal tube cuff pressure, and mucus collection cup and human pepsin ELISA kit were used to examine the samples. Samples were analyzed by ELISA technique. Two independent samples t test, one way analysis of variance, Mann Whitney U test and chi-square analysis were used for data analysis. Results: The mean age of the patients was 64.11 ± 17.21 years and 33,3% were female. The mean hospital stay was 6.30 ± 10.73 days, and the intensive care unit stay was 2.56 ± 4.42 days. The microaspiration rate was 19.8% in all patients. The rate of microaspiration was 22.2% in the pilot balloon finger palpation group, 20.0% in the intermittent control group, and 17.0% in the continuous control group. Continuous control reduces the rate of microaspiration of gastric contents, but there was no significant difference between the groups (p = 0.511). The ventilator-associated pneumonia rate was 4.2% in all patients. The rate of ventilator-associated pneumonia was 5.2% in the pilot balloon finger palpation group, 5.2% in the intermittent control group and 2.2% in the continuous control group. Continuous control reduces the rate of ventilator-associated pneumonia, but there was no significant difference between the groups (p = 0.897). Conclusions: Continuous endotracheal tube cuff pressure control provided normal endotracheal tube cuff pressure in intensive care unit patients, while gastric content microaspiration and ventilator-associated pneumonia decreased.