Continuous versus intermittent endotracheal cuff pressure control for the prevention of ventilator-associated respiratory infections in Vietnam: study protocol for a randomised controlled trial
<p><b>Background:</b> Ventilator-associated respiratory infection (VARI) comprises ventilator-associated pneumonia (VAP) and ventilator-associated tracheobronchitis (VAT). Although their diagnostic criteria vary, together these are the most common hospital-acquired infections in i...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
BioMed Central
2018
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| _version_ | 1826287587346612224 |
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| author | Dat, VQ Geskus, RB Wolbers, M Loan, HT Yen, LM Binh, NT Chien, LT Mai, NTH Phu, NH Lan, NPH Hao, NV Long, HB Thuy, TP Kinh, NV Trung, NV Phu, VD Cap, NT Trinh, DT Campbell, J Kestelyn, E Wertheim, HFL Wyncoll, D Thwaites, GE van Doorn, HR Thwaites, CL Nadjm, B |
| author_facet | Dat, VQ Geskus, RB Wolbers, M Loan, HT Yen, LM Binh, NT Chien, LT Mai, NTH Phu, NH Lan, NPH Hao, NV Long, HB Thuy, TP Kinh, NV Trung, NV Phu, VD Cap, NT Trinh, DT Campbell, J Kestelyn, E Wertheim, HFL Wyncoll, D Thwaites, GE van Doorn, HR Thwaites, CL Nadjm, B |
| author_sort | Dat, VQ |
| collection | OXFORD |
| description | <p><b>Background:</b> Ventilator-associated respiratory infection (VARI) comprises ventilator-associated pneumonia (VAP) and ventilator-associated tracheobronchitis (VAT). Although their diagnostic criteria vary, together these are the most common hospital-acquired infections in intensive care units (ICUs) worldwide, responsible for a large proportion of antibiotic use within ICUs. Evidence-based strategies for the prevention of VARI in resource-limited settings are lacking. Preventing the leakage of oropharyngeal secretions into the lung using continuous endotracheal cuff pressure control is a promising strategy. The aim of this study is to investigate the efficacy of automated, continuous endotracheal cuff pressure control in preventing the development of VARI and reducing antibiotic use in ICUs in Vietnam. </p><p><b>Methods/design:</b> This is an open-label randomised controlled multicentre trial. We will enrol 600 adult patients intubated for ≤ 24 h at the time of enrolment. Eligible patients will be stratified according to admission diagnosis (180 tetanus, 420 non-tetanus) and site and will be randomised in a 1:1 ratio to receive either (1) automated, continuous control of endotracheal cuff pressure or (2) intermittent measurement and control of endotracheal cuff pressure using a manual cuff pressure meter. The primary outcome is the occurrence of VARI, defined as either VAP or VAT during the ICU admission up to a maximum of 90 days after randomisation. Patients in both groups who are at risk for VARI will receive a standardised battery of investigations if their treating physician feels a new infection has occurred, the results of which will be used by an endpoint review committee, blinded to the allocated arm and independent of patient care, to determine the primary outcome. All enrolled patients will be followed for mortality and endotracheal tube cuff-related complications at 28 days and 90 days after randomisation. Other secondary outcomes include antibiotic use; days ventilated, in ICU and in hospital; inpatient mortality; costs of antibiotics in ICU; duration of ICU stay; and duration of hospital stay. </p><p><b>Discussion:</b> This study will provide high-quality evidence concerning the use of continuous endotracheal cuff pressure control as a method to reduce VARI, antibiotic use and hospitalisation costs and to shorten stay. </p><p><b>Trial registration:</b> ClinicalTrials.gov, <a href="https://clinicaltrials.gov/ct2/show/NCT02966392">NCT02966392</a>. Registered on November 9, 2016. Protocol version: 2.0; issue date March 3, 2017.</p> |
| first_indexed | 2024-03-07T02:00:52Z |
| format | Journal article |
| id | oxford-uuid:9d52ea19-3b87-40d0-a56b-bcf9945b17b2 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T02:00:52Z |
| publishDate | 2018 |
| publisher | BioMed Central |
| record_format | dspace |
| spelling | oxford-uuid:9d52ea19-3b87-40d0-a56b-bcf9945b17b22022-03-27T00:42:12ZContinuous versus intermittent endotracheal cuff pressure control for the prevention of ventilator-associated respiratory infections in Vietnam: study protocol for a randomised controlled trialJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:9d52ea19-3b87-40d0-a56b-bcf9945b17b2EnglishSymplectic Elements at OxfordBioMed Central2018Dat, VQGeskus, RBWolbers, MLoan, HTYen, LMBinh, NTChien, LTMai, NTHPhu, NHLan, NPHHao, NVLong, HBThuy, TPKinh, NVTrung, NVPhu, VDCap, NTTrinh, DTCampbell, JKestelyn, EWertheim, HFLWyncoll, DThwaites, GEvan Doorn, HRThwaites, CLNadjm, B <p><b>Background:</b> Ventilator-associated respiratory infection (VARI) comprises ventilator-associated pneumonia (VAP) and ventilator-associated tracheobronchitis (VAT). Although their diagnostic criteria vary, together these are the most common hospital-acquired infections in intensive care units (ICUs) worldwide, responsible for a large proportion of antibiotic use within ICUs. Evidence-based strategies for the prevention of VARI in resource-limited settings are lacking. Preventing the leakage of oropharyngeal secretions into the lung using continuous endotracheal cuff pressure control is a promising strategy. The aim of this study is to investigate the efficacy of automated, continuous endotracheal cuff pressure control in preventing the development of VARI and reducing antibiotic use in ICUs in Vietnam. </p><p><b>Methods/design:</b> This is an open-label randomised controlled multicentre trial. We will enrol 600 adult patients intubated for ≤ 24 h at the time of enrolment. Eligible patients will be stratified according to admission diagnosis (180 tetanus, 420 non-tetanus) and site and will be randomised in a 1:1 ratio to receive either (1) automated, continuous control of endotracheal cuff pressure or (2) intermittent measurement and control of endotracheal cuff pressure using a manual cuff pressure meter. The primary outcome is the occurrence of VARI, defined as either VAP or VAT during the ICU admission up to a maximum of 90 days after randomisation. Patients in both groups who are at risk for VARI will receive a standardised battery of investigations if their treating physician feels a new infection has occurred, the results of which will be used by an endpoint review committee, blinded to the allocated arm and independent of patient care, to determine the primary outcome. All enrolled patients will be followed for mortality and endotracheal tube cuff-related complications at 28 days and 90 days after randomisation. Other secondary outcomes include antibiotic use; days ventilated, in ICU and in hospital; inpatient mortality; costs of antibiotics in ICU; duration of ICU stay; and duration of hospital stay. </p><p><b>Discussion:</b> This study will provide high-quality evidence concerning the use of continuous endotracheal cuff pressure control as a method to reduce VARI, antibiotic use and hospitalisation costs and to shorten stay. </p><p><b>Trial registration:</b> ClinicalTrials.gov, <a href="https://clinicaltrials.gov/ct2/show/NCT02966392">NCT02966392</a>. Registered on November 9, 2016. Protocol version: 2.0; issue date March 3, 2017.</p> |
| spellingShingle | Dat, VQ Geskus, RB Wolbers, M Loan, HT Yen, LM Binh, NT Chien, LT Mai, NTH Phu, NH Lan, NPH Hao, NV Long, HB Thuy, TP Kinh, NV Trung, NV Phu, VD Cap, NT Trinh, DT Campbell, J Kestelyn, E Wertheim, HFL Wyncoll, D Thwaites, GE van Doorn, HR Thwaites, CL Nadjm, B Continuous versus intermittent endotracheal cuff pressure control for the prevention of ventilator-associated respiratory infections in Vietnam: study protocol for a randomised controlled trial |
| title | Continuous versus intermittent endotracheal cuff pressure control for the prevention of ventilator-associated respiratory infections in Vietnam: study protocol for a randomised controlled trial |
| title_full | Continuous versus intermittent endotracheal cuff pressure control for the prevention of ventilator-associated respiratory infections in Vietnam: study protocol for a randomised controlled trial |
| title_fullStr | Continuous versus intermittent endotracheal cuff pressure control for the prevention of ventilator-associated respiratory infections in Vietnam: study protocol for a randomised controlled trial |
| title_full_unstemmed | Continuous versus intermittent endotracheal cuff pressure control for the prevention of ventilator-associated respiratory infections in Vietnam: study protocol for a randomised controlled trial |
| title_short | Continuous versus intermittent endotracheal cuff pressure control for the prevention of ventilator-associated respiratory infections in Vietnam: study protocol for a randomised controlled trial |
| title_sort | continuous versus intermittent endotracheal cuff pressure control for the prevention of ventilator associated respiratory infections in vietnam study protocol for a randomised controlled trial |
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