VAP (Ventilator Acquired Pneumonia) is one of the major causes in ICU prologned stay or even dealth
For an ICU patient with the respiratory failure, the best possible treatment is to intubate the patient with a mechnical ventilator. Inspite of many of its clinical benefits, the invasive mechanical ventilator yet causes the patient to suffer with retained secretions due to several risk factors including mucus accumulation due to globlet cell excitation by ETT (Endotracheal Tube), subglottic infection due to bacteria located at the site above the ETT’s cuff, Atelectasis condition due to prolonged immobility and large mucus volume, impairment of cough, and secretion retention. What even worse when the muscus is aspirated into a lower respiratory tract which consequently causes Ventilator-Acquired Pneumonia or VAP.
VAP contributes to approximately half of all cases of hospital-acquired pneumonia. It is estimated to occur in 9–27 % of all mechanically ventilated patients, with the highest risk being early in the course of hospitalization. It is widely accepted that VAP is the second most common nosocomial infection in the ICU and the most common in mechanically ventilated patients.
Airway Clearance Therapy (ACT) is proved to be the best possible method to reduce VAP in mechanically-ventilated patient cases. But the current option bring many issues.
ACT has the potential to improve mucociliary clearance by reducing mucus plugging and enhancing the removal of secretions. It may result in improved ventilation, a reduction of airway obstruction and atelectasis, an improved ventilation-perfusion mismatch, and a decrease in proteolytic activity in the airway.
Up until today, routine suctioning via ETT is the most common method for ACT in ICU. It facilitates the removal of airway secretions, maintains airway patency and prevents pulmonary infection. However, tracheal suctioning has associated with the mucosa injury and other adverse sid-effects including decreased arterial oxygen tension. The suctioning must be done manually only by well-trained medical personnels. Also there is the need to temporarily stop the machanical ventilator operation which sometimes causes the loss of PEEP (Postive End-Expiratory Pressure) and potential lung derecruitement. This can be potentially serious in a pathient with high PEEP level and severe hypoxaemia.
Automatic Secretion Removal for Lower Respiratory Tract (CoughSync) – an innovative technology to protect VAP while reducing workload of the medical personels and infection in ICU room
The technique of artificially simulating a cough process – Mechanical In-Exsufflation (MI-E) – dates back to the era of the Polio epidemics 50 years ago. At that time, before the advent of ETT and catheter suction, cought simulation was extensively used for secretion removal in patients being ventilated non-ivasively with an iron lung. However, as intubation and catheter suction gained popularity in the 1960’s, MI-E disappeared from the ICU. In 1993, MI-E was brought back in therapy due to its many clinical benefits compaered to the suction cather; especially the secretion removal in the lower respiratory tract. MI-E was shown to be effective in those patients for routine secreton removal long-term, as well as during episodes of acute pneumonia.
Despite its unique advantages over the current suction cather method, MI-E still possesses some drawbacks. It not compatible with current mechnical ventilator. In fact, it is a stand-alone device and cannot be used with a mechanical ventilator; requiring aa patient to be completely disconnected from the ventilator; hence not suitable for a critically-illed patient.
In-Line Cough Simulation:
CoughSync is a so-called “Inine MI-E” version of an original MI-E. Only is it different in working principle. By these means, CoughSync, instead of being a stand-alone device, works in-line with the ventilator synchronously without interupting the patient’s ventilation at all. As a resut, cough simulation can be performed without having to disconnect the patient from the ventilator, and without interrupting delivery of enriched oxygen or PEEP. CoughSync is truely desinged for an ICU operation.