Comparison of Two Strategies for Endotracheal Tube Cuff Underinflation Prevention During Invasive Mechanical Ventilation
Comparison of Two Strategies for Endotracheal Tube Cuff Underinflation Prevention During Invasive Mechanical Ventilation
During invasive mechanical ventilation, maintaining endotracheal tube cuff pressure (Pcuff)
 around 25 cmH2O is recommended for sealing the upper airways. The continuous control of Pcuff
 with a simple mechanical device, the Tracoe Smart CuffmanagerTM, has never been assessed. The
 investigators hypothesize that the Tracoe Smart CuffmanagerTM would allow a reduction of the
 incidence of underinflation episodes, as compared with the intermittent strategy of Pcuff
 control.
During invasive mechanical ventilation, maintaining a tracheal cuff pressure (Pcuff) around
 25 cmH2O is recommended to prevent cuff over- (> 30 cmH2O) and underinflation (< 20 cmH2O),
 identified as risk factors for tracheal ischemic damage and for oropharyngeal
 microaspirations, respectively. Intermittent measurements with intermittent adjustments of
 Pcuff is the widely used strategy but, between measurements, over- and underinflation
 episodes could occur. Devices allowing a continuous control of Pcuff are therefore appealing.
 As microaspiration is the most relevant mechanism for ventilator-associated pneumonia (VAP),
 the use of such devices may decrease the incidence of VAP for instance. To the knowledge of
 the investigators, the continuous control of Pcuff with a simple mechanical device, the
 Tracoe Smart CuffmanagerTM, has never been assessed. The investigators hypothesize that the
 Tracoe Smart CuffmanagerTM would allow a reduction of the incidence of underinflation
 episodes, as compared with the intermittent strategy of Pcuff control. As secondary
 objectives, the investigators aim to assess the impact of the use of the Tracoe Smart
 CuffmanagerTM on the incidence of overinflation episodes and on the incidence of early
 ventilator-associated pneumonia. A homogenous population will be studied for this purpose:
 patients admitted with severe acute brain damage.
Inclusion Criteria:

 -  with severe acute brain damage

 -  admitted in the ICU for less than 48 hours

 -  and expected to receive invasive mechanical ventilation (through orotracheal tube with
 a low pressure-high volume cuff) for at least 48 hours after inclusion.

 Exclusion Criteria:

 -  change in the upper airway management within the 48 hours following the inclusion
 (extubation or change in the tracheal tube or tracheostomy)

 -  pregnancy, moribund status.