impact of the addition of a device providing continuous pneumatic regulation of tube cuff pressure to an overall strategy aimed at preventing ventilator-associated pneumonia in the severe trauma patient. a multicentre, randomised, controlled study.

Conditions: Ventilation-associated Pneumonia; Severe Trauma Patient

Summary: ventilation-associated pneumonia is the main site of healthcare-associated infections in the severe trauma patient, with a mean incidence rate of 35%. ventilator-associated pneumonia increases morbi-mortality, length of stay in intensive care and overall management costs. as was recalled by the jury of the 2008 sfar-srlf consensus conference on the prevention of nosocomial infections contracted in intensive care, success in this preventive endeavour depends on a number of measures: orotracheal intubation route, maintaining tube cuff pressure between 25 and 30 cm h2o, maintaining a semi-seated position ≥30°, nasal and oropharyngeal care at regular intervals, striving to avoid unscheduled extubation, and use of a written sedation-analgesia algorithm allowing for early weaning from ventilation. devices ensuring continuous pneumatic control of tube cuff pressure are more efficient in maintaining tracheal balloon pressure than intermittent adjustments using a hand-held manometer. in one study, these devices clearly facilitated diminution of microaspiration of gastric contents and of ventilator-associated pneumonia incidence density (9.7 vs. 22 vap/1000 days of mechanical ventilation; p = 0.005). the investigators are putting forward the hypothesis that by adjoining a device providing continuous pneumatic regulation of tube cuff pressure to an overall strategy aimed at ventilator-associated pneumonia prevention (including semi-recumbent position ≥30°, oro-nasal-pharyngeal care at regular intervals and reduced risk exposure) can decrease vap incidence by 50% in severely traumatised patients whose condition necessitates mechanical ventilation of an expected duration exceeding 48h. ours is the first large-scale study to evaluate the interest of an innovative technology bundle on decrease of ventilator-associated pneumonia incidence in one of the intensive care populations the most at risk, namely severe trauma patients, a population presently benefiting from the other recommended preventive measures.


Eligibility criteria:
inclusion criteria: * patients having a severe trauma as defined by an injury severity score (iss) \>15, * aged at least 18 years, * intubated for less than 15h, * necessitating recourse to mechanical ventilation for an expected period ≥ 48h, * participating in a social security scheme or benefiting from such a scheme by means of a third party. exclusion criteria: * patient likely to die over the 48h following admission, * nasotracheal intubation, * patient intubated through a tracheal tube with subglottic secretion drainage * intubation carried out 24h or more after the trauma, * ventilation with tracheotomy, * refusal to participate in the research, * contraindication to the head-up position, * participation in another research protocol focusing on an anti-infective treatment or on a measure decreasing the risk of infection, * persons benefiting from reinforced protection or persons deprived of freedom subsequent to a legal or administrative decision, minors under legal protection

Keywords: critical care trauma patients