A Literature Review on Strategies Preventing Ventilator-Associated Pneumonia: Role of Endotracheal Cuff Pressure, Cuff Material, and Cuff Shape

Objectives: To provide an overview of existing literature regarding the effects of ETT cuff pressure, cuff material, and cuff shape on VAP prevention in adult ventilated patients. Background: Ventilated patients are at risk of ventilator-associated pneumonia (VAP), which can result in many adverse consequences, such as increased length of stay, mortality, and hospital cost. Endotracheal tube (ETT) insertion is a commonly used measure for mechanical ventilation. However, ETT cuff pressure, special cuff material, and special cuff shape may affect the occurrence of VAP in ventilated patients, but the evidence for their effects on VAP prevention has not been synthesized. Methods: A literature review was conducted. Findings: Twenty-two studies involving 8,809 patients were included in this literature review. The reviewed studies showed inconsistent findings of the effects of continuous ETT cuff pressure monitoring (compared with intermittent pressure monitoring), polyurethane ultrathin tracheal tube (compared with polyvinyl chloride tracheal tube), and taper-shaped cuff (compared with conical-shaped cuff) on the prevention of VAP. Two studies reported consistent findings that silver-coated ETT significantly reduced bacterial load and incidence of VAP compared with uncoated ETT, but the evidence level was relatively weak. Conclusion: This literature review provides an initial and brief overview of the effects of ETT cuff pressure, cuff material, and cuff shape on preventing VAP. However, the effectiveness of these interventions remains inconclusive due to the inadequate evidence and low quality of previous studies. The intervention effects should be synthesized using a quantitative method and laboratory studies with rigorous design are needed to provide more solid evidence.