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Ventilator-associated pneumonia and new airway technologies

Specialist Registrar in Anaesthesia, Queen Elizabeth Hospital, Gayton Road, Kings Lynn, PE30 4ET, 01553 613457, UK

Peter Young

Consultant, Critical Care Unit, Queen Elizabeth Hospital, Gayton Road, Kings Lynn, PE30 4ET, 01553 613457, UK, Peteryoung{at}eaicg.com

Current endotracheal and tracheostomy tubes have high volume low pressure cuffs. These cuffs are ineffective at preventing the ongoing pulmonary aspiration of oropharyngeal and gastric contents. This ubiquitous complication of intubation is the most important cause of ventilator-associated pneumonia (VAP), the commonest and most devastating nosocomial infection in the Intensive Care Unit (ICU). Current tracheal tubes are made of relatively fixed curved PVC, and this produces forces on the airway tissues which is associated with laryngeal and tracheal injury. There is a need for the development of tracheal tube technologies to prevent aspiration injury and the reduce airway injury associated with mechanical ventilation of the critically ill. Given the costs associated with VAP there is currently a massive mismatch in what we spend on prevention.

Key Words: ventilator-associated pneumonia (VAP) • prevention • endotracheal tube (ETT) • upper airway injury • aspiration • airway technology

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