Effectiveness of Continuous Automatic Endotracheal Cuff Pressure Monitoring in Preventing Ventilator-Associated Pneumonia in the Pediatric Intensive Care Unit: A Randomized Controlled Trial
In brief
Automatic cuff monitoring lowers pediatric ventilator pneumonia from 24% to 13%
In an open-label randomized trial of 241 ventilated children, ventilator-associated pneumonia within 28 days occurred in 13.3% with continuous automatic monitoring versus 24.0% with manual checks, an absolute reduction of about 11 percentage points. Automated monitoring also improved time in the target cuff-pressure range, but ventilation-day rates and unadjusted time-to-diagnosis analyses were not conclusive, so replication is needed.
- Journal
- Chest (Q1)
- Published
- 10 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Ayşe Aşık, Muhterem Duyu, Saime Hacer Özdemir Dağhan, Pelin Pehlivan, Burçin Türkmen, Nergiz Alçınkaya Sevinç, et al.
- PMID
- 42858808
- DOI
- 10.1016/j.chest.2026.10.003
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (paper of the day, 12 October 2026): Continuous cuff pressure monitoring reduces VAP incidence
- Picked for Pediatrics and Child Health (paper of the day, 12 October 2026): RCT of cuff pressure monitoring to prevent VAP
Abstract
BACKGROUND: Ventilator-associated pneumonia (VAP) is a major healthcare-associated infection in critically ill children, primarily driven by microaspiration around the endotracheal tube cuff. RESEARCH QUESTION: Does continuous automatic cuff pressure monitoring (CACPM) reduce the incidence of VAP compared to intermittent manual cuff pressure monitoring (IMCPM) in critically ill pediatric patients requiring mechanical ventilation? STUDY DESIGN AND METHODS: In this open-label, randomized controlled superiority trial, pediatric patients requiring mechanical ventilation for ≥48 hours were randomly assigned (1:1) to either CACPM or IMCPM. The target cuff pressure was strictly maintained at 20-25 cmH2O. The primary outcome was the proportion of patients developing VAP within 28 days following intubation, evaluated in the intention to treat population. Secondary outcomes included time to VAP diagnosis and target pressure compliance. Statistical approaches included Kaplan-Meier survival analysis and multivariable Cox proportional hazard regression. RESULTS: Among 241 randomized patients, ITT analysis showed lower VAP with CACPM than IMCPM (13.3% vs 24.0%; risk difference, -10.6 percentage points; 95% CI, -20.3 to -0.8; P=0.034), with similar PP findings (15.0% vs 26.6%; P=0.044). ITT incidence density was 15.7 vs 27.1 per 1,000 ventilator-days (IRR, 1.73; 95% CI, 0.94-3.18; P=0.080). Unadjusted time-to-VAP was nonsignificant (HR, 1.80; 95% CI, 0.976-3.321; P=0.060), whereas adjusted Cox analysis narrowly indicated a higher VAP hazard with IMCPM (HR, 1.90; 95% CI, 1.024-3.510; P=0.042). Target-pressure compliance was higher with CACPM (P<0.001). INTERPRETATION: CACPM significantly reduces the proportion of critically ill pediatric patients developing VAP compared with IMCPM. This preventive effect appears directly linked to improved target pressure compliance, suggesting that automated regulation could be a valuable addition to pediatric VAP prevention strategies. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT05918172.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.