Integrated vs Manual Endotracheal Tube Cuff Pressure Monitoring and Ventilator-Associated Pneumonia

This single-center prospective cohort study enrolled consecutively screened ICU patients requiring invasive mechanical ventilation after severe head injury. Participants were allocated to exposure groups based on the ventilator to which they were connected at ICU admission, without investigator influence: (1) integrated continuous cuff pressure control via HAMILTON-C6 ventilator, or (2) intermittent manual cuff pressure checks using a manometer according to standard practice (every 8 hours and additionally during nursing/diagnostic-therapeutic procedures as needed), targeting cuff pressures of 20-30 cmH₂O.

Participants were followed for up to 7 days in ICU for development of VAP. VAP assessment used clinical, laboratory, radiological, and microbiological data summarized using the Clinical Pulmonary Infection Score (CPIS). Standard VAP prevention bundle measures were applied to both groups per unit protocol. All patients received prophylactic amoxicillin/clavulanic acid 1.2 g IV every 8 hours according to local protocol.

Inclusion criteria

• ICU admission after severe head injury
• Endotracheal intubation and invasive mechanical ventilation
• Expected mechanical ventilation >48-72 hours (recommended to add for PRS clarity)
• Informed consent from family/legal representative

Exclusion criteria

• Pneumonia/VAP diagnosed within the first 48 hours of ICU admission/ventilation
• Removal or replacement of endotracheal tube during observation window
• Tracheotomy performed within 7 days of admission
• Missing required assessments/results (optional to include as operational exclusion)