Background
Aims
This study evaluated whether automated cuff pressure control better maintains target pressure than manual monitoring in ventilated children, and assessed its effects on off-target pressure and workload.
Methods
In this prospective, randomized crossover study, mechanically ventilated pediatric patients (1 month–18 years) expected to require ventilation for ≥ 48 h underwent two randomized 24-h monitoring phases (manual and automated). During the manual phase, cuff pressure was continuously displayed via a closed system without repeated disconnection of the manometer and was intermittently adjusted by bedside nurses according to a predefined protocol. During the automated phase, cuff pressure was continuously regulated using an automated control system to maintain a target range of 15–25 cmH2O. The primary outcomes were the frequency and cumulative duration of off-target cuff pressure exposure; secondary outcomes included nursing workload.
Results
Thirty-two patients completed both phases (768 measurements). Low cuff pressure episodes (< 15 cmH2O) were more frequent during manual monitoring than automated monitoring (12.7% vs. 1.3%, p < 0.001), while high-pressure episodes (> 25 cmH2O) occurred only during manual monitoring (2.6% vs. 0%, p < 0.001). Total time outside the target range was markedly reduced with automated monitoring (118 vs. 10 h, p < 0.001). Nursing workload was significantly lower in the automated phase (3.65 h vs. 0.08 h, p < 0.001).
Conclusions
Automated cuff pressure control more reliably maintains target pressure and minimizes clinically important deviations compared to manual management. These results support adopting continuous automated regulation as a preferred strategy to enhance airway safety and reduce workload in mechanically ventilated children.