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Modification of Tracheal Cuff Shape and Continuous Cuff Pressure Control to Prevent Microaspiration in an Ex Vivo Pig Tracheal Two-Lung Model

Monsel, Antoine MD, PhD1; Le Corre, Marine MD, MSc1; Deransy, Romain MD, MSc1; Brisson, Hélène MD, MSc1; Arbelot, Charlotte MD1; Lu, Qin MD, PhD1; Golmard, Jean-Louis MD, PhD2; Langeron, Olivier MD, PhD1; Rouby, Jean-Jacques MD, PhD1

doi: 10.1097/CCM.0000000000002764
Online Laboratory Investigations
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Objectives: Microaspiration of subglottic secretions plays a pivotal role in ventilator-associated pneumonia. Impact of endotracheal tube cuff material and shape on tracheal sealing performance remains debated. The primary objective was to compare the tracheal sealing performance of polyvinyl chloride tapered, cylindrical and spherical cuffs. Secondary objectives were to determine the impact of continuous cuff pressure control on sealing performance and pressure variability.

Design: Prospective randomized ex vivo animal study.

Setting: French research laboratory.

Subjects: Seventy-two ex vivo pig tracheal two-lung blocks.

Interventions: Blocks were randomly intubated with cylindrical (n = 26), tapered (n = 24), or spherical (n = 22) polyvinyl chloride endotracheal tube cuffs. Two milliliter of methylene blue were instilled above the cuff to quantify microaspirations, and lungs were ventilated for 2 hours. Continuous cuff pressure control was implemented in 33 blocks.

Measurements and Main Results: Cuff pressures were continuously recorded, and after 2 hours, a microaspiration score was calculated. Tapered cuffs improved cuff sealing performance compared with spherical cuffs with or without continuous cuff pressure control. Compared with spherical cuffs, tapered cuffs reduced the microaspiration score without and with continuous pressure control by 65% and 72%, respectively. Continuous cuff pressure control did not impact sealing performance. Tapered cuffs generated higher cuff pressures and increased the time spent with overinflation compared with spherical cuffs (median [interquartile range], 77.9% [0–99.8] vs. 0% [0–0.5]; p = 0.03). Continuous cuff pressure control reduced the variability of tapered and spherical cuffs likewise the time spent with overinflation of tapered and cylindrical cuffs.

Conclusions: Polyvinyl chloride tapered cuffs sealing enhanced performance at the cost of an increase in cuff pressure and in time spent with overinflation. Continuous cuff pressure control reduced the variability and normalized cuff pressures without impacting sealing performance.

1Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié–Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, UPMC Université, Paris, France.

2Department of Biostatistic, ER4/EA3974, UPMC Université, Paris, France.

Supported, in part, by institutional and/or department sources.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: antoine.monsel@gmail.com

Copyright © 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.