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Cuff Pressures and the Prevention of VAP
- As highlighted in a recent pearl, ventilator-associated pneumonia (VAP) is the second most common nosocomial infection in the US and is associated with increases in ICU length of stay and mortality.
- With increasing ED lengths of stay for many critically ill patients receiving mechanical ventilation, measures to prevent VAP should be initiated in the ED.
- In addition to elevating the head of the bed to 30-45 degrees, another low cost intervention is the measurement of endotracheal tube cuff pressures.
- Cuff pressures below 20 cm H2O increase the risk of VAP.
- Measure cuff pressure within 4 hours of inflation and maintain between 20-30 cm H2O.
References
Grap MJ, et al. Ventilator-associated pneumonia: The potential critical role of emergency medicine in prevention. JEM 2012; 42:353-362.