Critical Care
Volume 12
Issue 6 |
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Still not addressing the pivotal problem in VAP
Duncan Wyncoll
(19 November 2008) Guy 
I agree with the authors that the major cause of VAP is aspiration of microorganisms from the oropharynx into the respiratory tract. However, the real final common pathway in the pathogenesis of VAP is aspiration of (colonised) secretions past the cuff of the tracheal tube. Aspiration is almost universal because of a design defect in almost all tracheal tube cuffs, which allow leakage through internal folds in the cuff wall. If there was more interest taken by clinicians and manufacturers in providing truly effective cuffs then it would matter less whether the mouth was applied with chlorhexidine or Lactobacillus.
Competing interests
DW received one speaker fee in 2006 from Venner Capital, the manufacturer of LoTrach tubes.
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