Abstract
BackgroundMicroaspiration past the tracheal tube cuffs causes ventilator-associated pneumonia. The objective of the current study was to evaluate whether creating negative pressure between the tracheal double cuffs could block the fluid passage past the tracheal tube cuffs.MethodsA new negative pressure system was devised between the double cuffs through a suction hole in the intercuff space. Blue-dyed water was instilled above the cuff at negative suction pressures of − 54, − 68, − 82, − 95, − 109, − 122, and − 136 cmH2O, and the volume leaked was measured in an underlying water trap after 10 min. Leakage tests were also performed during positive pressure ventilation, and using higher-viscosity materials. The actual negative pressures delivered at the hole of double cuffs were obtained by placing microcatheter tip between the intercuff space and the artificial trachea.ResultsNo leakage occurred past the double cuff at − 136 cmH2O suction pressure at all tracheal tube cuff pressures. The volume leaked decreased significantly as suction pressure increased. When connected to a mechanical ventilator, no leakage was found at − 54 cmH2suction pressure. Volume of the higher-viscosity materials (dynamic viscosity of 63–108 cP <cP> and 370–430 cP) leaked was small compared to that of normal saline (0.9–1.1 cP). The pressures measured in the intercuff space corresponded to 3.8–5.9% of those applied.ConclusionsA new prototype double cuff with negative pressure in the intercuff space completely prevented water leakage. The negative pressure transmitted to the tracheal inner wall was a small percentage of that applied.
Highlights
Microaspiration past the tracheal tube cuffs causes ventilator-associated pneumonia
Since microaspiration of the accumulated secretions around the endotracheal tube cuff is the primary mechanism of ventilator-associated pneumonia (VAP), subglottic secretion suctioning has been recommended in several guidelines to avoid the occurrence of VAP [16, 17]
The present study demonstrated that application of an appropriate negative suction pressure to the intercuff space of the new tracheal tube completely blocked saline leakage past the cuffs
Summary
Microaspiration past the tracheal tube cuffs causes ventilator-associated pneumonia. Numerous reports have described the attempts to prevent leakage of oropharyngeal secretions past tracheal tube cuffs. Those methods included the use of various cuff shapes and tracheal tube materials [10, 11], applying positive end expiratory pressure to mechanical ventilation [12] or various suction techniques [13, 14], and lubricating the cuff with gel [15]. Since microaspiration of the accumulated secretions around the endotracheal tube cuff is the primary mechanism of VAP, subglottic secretion suctioning has been recommended in several guidelines to avoid the occurrence of VAP [16, 17]. Subglottic secretion suction is known to decrease VAP incidence, reduce duration of mechanical ventilation and delay VAP onset [17, 18]
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