Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Leung HYG(1)
Yeung MS (1)
Chan LSY (1)
Chan MY (1)
Affiliation :
(1)Yan Chai Hospital/ Hospital Authority
Introduction :
Under-inflation of tracheal cuff pressure (Pcuff) is associated with four time increased risk of micro-aspiration and Ventilator-associated Pneumonia (VAP) than higher Pcuff. The efficacy of maintaining a safe Pcuff by Intermittent Cuff Pressure Control is questionable as study indicates that 45% of Pcuff was under-inflated 2 hours after manual adjustment.
Objectives :
An Evidence Based Practice Project was performed to explore our queries: Is Continuous Tracheal Cuff Pressure Control (CCPC) better than Intermittent Cuff Pressure Control (ICPC) in reducing VAP among intubated patients in Intensive Care Units?
Methodology :
2 Systematic Reviews and 3 Randomised Control Studies were identified and reviwed in Literature Search, which were then appraised as good quality and were selected for our project. The summarized results indicated that CCPC was associated with a decrease in VAP and a lower incidence of Pcuff under-inflation. A staff empowerment program and nursing guideline on the use of CCPC was launched to enhance nurses' knowledge and skill. In 2022, CCPC was applied to all intubated patients in YCH ICU. Nurses were asked to document the use of the device. Data was collected and extracted for synthesis and evaluation.
Result & Outcome :
Results: 315 intubated patients were recruited in our program. 42% were medical patients, while the remaining 58% were surgery-related patients including Orthopedics, Ear-Nose-Throat, and General Surgery. Compared to 2021, the VAP rate (cases/ ventilator days X1000) decreased from 1.8 to 0.9. However, the use of CCPC was not associated with reduction in ventilator days and ICU length of stay. Conclusion: CCPC was associated with a lower incidence of VAP when compared to ICPC. CCPC is recommended for other hospitals and ward settings. Large scale studies should be carried out to evaluate its effect on different specialties in intubated patients.
