Mechanical Modulation of Cuff Pressure Reduces Airway Injury

Abstract

Objective: Test a valve-based mechanical means of modulating endotracheal tube cuff pressure and its efficacy in reducing airway injury. Method: We developed a mechanical valve-based device that modulates endotracheal tube cuff pressure with the respiratory cycle. We tested this device in a previously validated porcine model of accelerated airway injury. Laryngeal specimens from animals intubated with a modulated cuff pressure were compared to those intubated with a constant cuff pressure. Results: We have demonstrated that the valve-based device adequately maintains ventilation. Furthermore, there was a significant reduction in the amount of histologically evident injury to the subglottic and tracheal areas of the airway in those animals that were maintained with a modulated cuff pressure. There was no difference between the 2 animal groups in the degree of supraglottic or glottic injury. Conclusion: This valve-based system is inexpensive, reliable, and effective in reducing airway injury. Validation of this device in the clinical setting would allow its widespread application and potentially result in a significant reduction in airway injury from prolonged intubation.