The effect of endotracheal tube cuff pressure (minimum/maximum) in the prevention of ventilator-induced pneumonia in patients admitted to ICU

Determining and comparing the incidence of late-onset pneumonia in the two studied groups

Patients will be divided into groups by block randomization method (block size 4). Randomization is performed by an epidemiologist or using the online program at sealedevelope.com. Due to the double-blind nature of the study, the data collector and the data analyst do not know about our grouping, but the anesthesiologist who is on the patient's bed during surgery knows about the grouping

The intervention is performed in the ICU of Valiasr Hospital. In this study, the patients, as well as the project data analyst and the intern who is responsible for completing the questionnaires, will be unaware of the division of patients into two groups.

Inclusion criteria Patients requiring mechanical ventilation Age 18 to 65 years؛ Absence of lung disease and lung mass؛ No use of chemotherapy drugs؛ Absence of enteral nutrition؛ Failure to receive antibiotics prior to onset of VAP Exclusion criteria Patients who require mechanical ventilation for less than 48 hours (because they are at low risk of VAP)؛ death؛ Lack of consent to participate in the study by the guardian Reintubation

Intervention group: In one group, the cuff pressure is considered to be at least normal and its amount will be 20 to 22 cm of water. In order to check the cuff pressure, it will be measured by a manometer every 4 hours. Intervention group: cuff pressure will be considered as maximum normal and its amount will be 30 to 32 cm of water. In order to check the cuff pressure, it will be measured by a manometer every 4 hours.

Duration of mechanical ventilation and mortality and incidence of pneumonia with early onset and late onset in patients will be recorded. The severity of the disease will be recorded daily for three days.

Patients will be divided into 2 groups by block randomization method (block size 4). Case sequencing is performed by an epidemiologist using an online program at www.sealedevelope.com. Hiding the random chain is done by the method of opaque envelopes.

Due to the double-blind nature of the study, the patients and the data collector and the data analyst do not know about the groupings, but the anesthesiologist who is at the patient's bedside during surgery and knows about the grouping.