Abstract
BackgroundThe primary objective of this study was to determine the efficiency of a pneumatic device in controlling cuff pressure (Pcuff) in patients intubated with polyurethane-cuffed tracheal tubes. Secondary objectives were to determine the impact of continuous control of Pcuff, and cuff shape on microaspiration of gastric contents.MethodsProspective 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 Pcuff using a pneumatic device (Nosten®), and 24 h of routine care of Pcuff using a manometer. Target Pcuff was 25 cmH2O. Pcuff was continuously recorded, and pepsin was quantitatively measured in all tracheal aspirates during these periods.ResultsThe pneumatic device was efficient in controlling Pcuff (med [IQ] 26 [24, 28] vs 22 [20, 28] cmH2O, during continuous control of Pcuff 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 Pcuff compared with routine care.No significant difference was found in microaspiration of gastric content between continuous control of Pcuff compared with routine care, or between patients intubated with tapered compared with cylindrical polyurethane-cuffed tracheal tubes.ConclusionThe pneumatic device was efficient in controlling Pcuff in critically ill patients intubated with polyurethane-cuffed tracheal tubes.Trial registrationThe Australian New Zealand Clinical Trials Registry (NCT01351259)
Highlights
The primary objective of this study was to determine the efficiency of a pneumatic device in controlling cuff pressure (Pcuff) in patients intubated with polyurethane-cuffed tracheal tubes
No significant difference was found in patient characteristics between the two periods of continuous control of Cuff pressure (Pcuff) and routine care, or between patients intubated with tapered-cuffed tracheal tubes, and those intubated with cylindrical-cuffed tracheal tubes (Tables 1, and 2)
Impact of cuff shape on microaspiration No significant difference was found in microaspiration of gastric content rate, mean pepsin level or percentage of tracheal aspirates positive for pepsin between patients intubated with tapered-cuffed tracheal tubes and those intubated with cylindrical-cuffed tracheal tubes during continuous control of Pcuff or routine care (Table 4)
Summary
The primary objective of this study was to determine the efficiency of a pneumatic device in controlling cuff pressure (Pcuff) in patients intubated with polyurethane-cuffed tracheal tubes. Polyurethane-cuffed tracheal tubes were reported to significantly reduce leakage in in vitro studies, and microaspiration in intubated critically ill patients [5,6,7]. Three clinical studies reported significant reduction in VAP, and nosocomial pneumonia rate in patients intubated with polyurethane-cuffed tracheal tubes compared with those intubated with standard polyvinyl chloride-cuffed tracheal tubes [8,9,10]. Limitations of these studies, including the use of subglottic aspiration in the intervention group in one study, clinical definition of nosocomial pneumonia, and beforeafter design should be taken into account. Recent data coming from in vitro studies suggested a beneficial effect of tapered-shaped tracheal cuff in reducing microaspiration [11,12,13]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call