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Open Access 01-12-2013 | Research article

Efficiency of a pneumatic device in controlling cuff pressure of polyurethane-cuffed tracheal tubes: a randomized controlled study

Authors: Emmanuelle Jaillette, Farid Zerimech, Julien De Jonckheere, Demosthenes Makris, Malika Balduyck, Alain Durocher, Alain Duhamel, Saad Nseir

Published in: BMC Anesthesiology | Issue 1/2013

Abstract

Background

The primary objective of this study was to determine the efficiency of a pneumatic device in controlling cuff pressure (P_cuff) in patients intubated with polyurethane-cuffed tracheal tubes. Secondary objectives were to determine the impact of continuous control of P_cuff, and cuff shape on microaspiration of gastric contents.

Methods

Prospective randomized controlled study. All patients requiring intubation and mechanical ventilation ≥48 h were eligible. The first 32 patients were intubated with tapered polyurethane-cuffed, and the 32 following patients were intubated with cylindrical polyurethane-cuffed tracheal tubes. Patients randomly received 24 h of continuous control of P_cuff using a pneumatic device (Nosten®), and 24 h of routine care of P_cuff using a manometer. Target P_cuff was 25 cmH₂O. P_cuff was continuously recorded, and pepsin was quantitatively measured in all tracheal aspirates during these periods.

Results

The pneumatic device was efficient in controlling P_cuff (med [IQ] 26 [24, 28] vs 22 [20, 28] cmH₂O, during continuous control of P_cuff and routine care, respectively; p = 0.017). In addition, percentage of patients with underinflation (31% vs 68%) or overinflation (53% vs 100%) of tracheal cuff, and percentage of time spent with underinflation (0.9 [0, 17] vs 14% [4, 30]) or overinflation (0 [0, 2] vs 32% [9, 54]) were significantly (p < 0.001) reduced during continuous control of P_cuff compared with routine care.

No significant difference was found in microaspiration of gastric content between continuous control of P_cuff compared with routine care, or between patients intubated with tapered compared with cylindrical polyurethane-cuffed tracheal tubes.

Conclusion

The pneumatic device was efficient in controlling P_cuff in critically ill patients intubated with polyurethane-cuffed tracheal tubes.

Trial registration

The Australian New Zealand Clinical Trials Registry (NCT01351259)

Available only for authorised users

Nseir S, Zerimech F, Jaillette E, Artru F, Balduyck M: Microaspiration in intubated critically ill patients: diagnosis and prevention. Infect Disor Drug Target. 2011, 11: 413-423. 10.2174/187152611796504827.CrossRef

Craven DE, Chroneou A, Zias N, Hjalmarson KI: Ventilator-associated tracheobronchitis: the impact of targeted antibiotic therapy on patient outcomes. Chest. 2009, 135: 521-528. 10.1378/chest.08-1617.CrossRefPubMed

Bouadma L, Wolff M, Lucet J-C: Ventilator-associated pneumonia and its prevention. Curr Opin Infect Dis. 2012, 25: 395-404. 10.1097/QCO.0b013e328355a835.CrossRefPubMed

Coppadoro A, Bittner E, Berra L: Novel preventive strategies for ventilator-associated pneumonia. Crit Care. 2012, 16: 210-10.1186/cc11225.CrossRefPubMedPubMedCentral

Lucangelo U, Zin WA, Antonaglia V, Petrucci L, Viviani M, Buscema G, Borelli M, Berlot G: Effect of positive expiratory pressure and type of tracheal cuff on the incidence of aspiration in mechanically ventilated patients in an intensive care unit. Crit Care Med. 2008, 36: 409-413. 10.1097/01.CCM.0000297888.82492.31.CrossRefPubMed

Nseir S, Zerimech F, De Jonckheere J, Alves I, Balduyck M, Durocher A: Impact of polyurethane on variations in tracheal cuff pressure in critically ill patients: a prospective observational study. Intensive Care Med. 2010, 36: 1156-1163. 10.1007/s00134-010-1892-7.CrossRefPubMed

Dullenkopf A, Gerber A, Weiss M: Fluid leakage past tracheal tube cuffs: evaluation of the new Microcuff endotracheal tube. Intensive Care Med. 2003, 29: 1849-1853. 10.1007/s00134-003-1933-6.CrossRefPubMed

Lorente L, Lecuona M, Jiménez A, Mora ML, Sierra A: Influence of an endotracheal tube with polyurethane cuff and subglottic secretion drainage on pneumonia. Am J Respir Crit Care Med. 2007, 176: 1079-1083. 10.1164/rccm.200705-761OC.CrossRefPubMed

Poelaert J, Depuydt P, De Wolf A, Van de Velde S, Herck I, Blot S: Polyurethane cuffed endotracheal tubes to prevent early postoperative pneumonia after cardiac surgery: a pilot study. J Thor Cardiovascular Surg. 2008, 135: 771-776. 10.1016/j.jtcvs.2007.08.052.CrossRef

10.

Miller MA, Arndt JL, Konkle MA, Chenoweth CE, Iwashyna TJ, Flaherty KR, Hyzy RC: A polyurethane cuffed endotracheal tube is associated with decreased rates of ventilator-associated pneumonia. J Crit Care. 2011, 26: 280-286. 10.1016/j.jcrc.2010.05.035.CrossRefPubMed

11.

Madjdpour C, Mauch J, Dave MH, Spielmann N, Weiss M: Comparison of air-sealing characteristics of tapered- vs. cylindrical-shaped high-volume, low-pressure tube cuffs. Acta Anaesthesiol Scand. 2012, 56: 230-235. 10.1111/j.1399-6576.2011.02542.x.CrossRefPubMed

12.

Dave MH, Frotzler A, Spielmann N, Madjdpour C, Weiss M: Effect of tracheal tube cuff shape on fluid leakage across the cuff: an in vitro study. Brit J Anaesthesia. 2010, 105: 538-543. 10.1093/bja/aeq202.CrossRef

13.

Zanella A, Scaravilli V, Isgrò S, Milan M, Cressoni M, Patroniti N, Fumagalli R, Pesenti A: Fluid leakage across tracheal tube cuff, effect of different cuff material, shape, and positive expiratory pressure: a bench-top study. Intensive Care Med. 2011, 37: 343-347. 10.1007/s00134-010-2106-z.CrossRefPubMed

14.

Young PJ, Rollinson M, Downward G, Henderson S: Leakage of fluid past the tracheal tube cuff in a benchtop model. Brit J Anaesthesia. 1997, 78: 557-562. 10.1093/bja/78.5.557.CrossRef

15.

Rello J, Soñora R, Jubert P, Artigas A, Rué M, Vallés J: Pneumonia in intubated patients: role of respiratory airway care. Am J Respir Crit Care Med. 1996, 154: 111-115. 10.1164/ajrccm.154.1.8680665.CrossRefPubMed

16.

Seegobin RD, van Hasselt GL: Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs. Brit Med J. 1984, 288: 965-968. 10.1136/bmj.288.6422.965.CrossRef

17.

Nseir S, Brisson H, Marquette C-H, Chaud P, Di Pompeo C, Diarra M, Durocher A: Variations in endotracheal cuff pressure in intubated critically ill patients: prevalence and risk factors. Eur J Anaesthsiol. 2009, 26: 229-234. 10.1097/EJA.0b013e3283222b6e.CrossRef

18.

Nseir S, Zerimech F, Fournier C, Lubret R, Ramon P, Durocher A, Balduyck M: Continuous control of tracheal cuff pressure and microaspiration of gastric contents in critically ill patients. Am J Respir Crit Care Med. 2011, 184: 1041-1047. 10.1164/rccm.201104-0630OC.CrossRefPubMed

19.

Chastre J, Bedock B, Clair B, Gehanno P, Lacaze T, Lesieur O, Picart-Jacq JY, Plaisance P, Ravussin P, Samain E, et al: Quel abord trachéal pour la ventilation mécanique des malades de réanimation? (à l’exclusion du nouveau né). Reanimation. 1998, 7: 438-442.

20.

Duguet A, D’Amico L, Biondi G, Prodanovic H, Gonzalez-Bermejo J, Similowski T: Control of tracheal cuff pressure: a pilot study using a pneumatic device. Intensive Care Med. 2007, 33: 128-132. 10.1007/s00134-006-0417-x.CrossRefPubMed

21.

Nseir S, Duguet A, Copin M-C, De Jonckheere J, Zhang M, Similowski T, Marquette C-H: Continuous control of endotracheal cuff pressure and tracheal wall damage: a randomized controlled animal study. Crit Care. 2007, 11: R109-10.1186/cc6142.CrossRefPubMedPubMedCentral

22.

Guyton DC, Barlow MR, Besselievre TR: Influence of airway pressure on minimum occlusive endotracheal tube cuff pressure. Crit Care Med. 1997, 25: 91-94. 10.1097/00003246-199701000-00018.CrossRefPubMed

23.

Blanch PB: Laboratory evaluation of 4 brands of endotracheal tube cuff inflator. Respir Care. 2004, 49: 166-173.PubMed

24.

Valta P, Corbeil C, Chassé M, Braidy J, Milic-Emili J: Mean airway pressure as an index of mean alveolar pressure. Am J Respir Crit Care Med. 1996, 153: 1825-1830. 10.1164/ajrccm.153.6.8665041.CrossRefPubMed

25.

Sole ML, Su X, Talbert S, Penoyer DA, Kalita S, Jimenez E, Ludy JE, Bennett M: Evaluation of an intervention to maintain endotracheal tube cuff pressure within therapeutic range. Am J Crit Care. 2011, 20: 109-117. 10.4037/ajcc2011661.CrossRefPubMedPubMedCentral

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2253/13/50/prepub

Title: Efficiency of a pneumatic device in controlling cuff pressure of polyurethane-cuffed tracheal tubes: a randomized controlled study
Authors: Emmanuelle Jaillette
Farid Zerimech
Julien De Jonckheere
Demosthenes Makris
Malika Balduyck
Alain Durocher
Alain Duhamel
Saad Nseir
Publication date: 01-12-2013
Publisher: BioMed Central
Published in: BMC Anesthesiology / Issue 1/2013
Electronic ISSN: 1471-2253
DOI: https://doi.org/10.1186/1471-2253-13-50

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Efficiency of a pneumatic device in controlling cuff pressure of polyurethane-cuffed tracheal tubes: a randomized controlled study

Abstract

Background

Methods

Results

Conclusion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

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