A low-volume, low-pressure tracheal tube cuff reduces pulmonary aspiration*

Young, Peter; Pakeerathan, Sivarajasingham; Blunt, Mark; Subramanya, Sriharsha

doi:10.1097/01.ccm.0000201406.57821.5b

Cited by 125 publications

(115 citation statements)

References 33 publications

(47 reference statements)

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“…Moreover, unavoidable ETT movement that occurs during routine care (and particularly during intra-hospital transport) enhances microaspiration. 72,74,75 This is supported by evidence suggesting that unavoidable movement of the ETT related to routine care such as ETT repositioning is an independent risk factor for VAP (odds ratio of 3.11, 95% CI 1.03-9.42, P ϭ .04). 76 Attaining a cuff seal that prevents gross aspiration around the ETT requires intra-cuff pressures of 20 -30 cm H 2 O.…”

Section: Pathophysiology Of Ventilator-associated Pneumoniasupporting

confidence: 58%

“…84 Laboratory studies have consistently demonstrated that polyurethane-cuffed ETTs (and similarly designed silicone cuffs) are superior to standard polyvinyl cuffs in minimizing fluid leakage. 70,71,75,[85][86][87] Significantly reduced microaspiration has been reproduced in clinical trials, 75,78 coinciding with significant reductions in VAP (26 -45% relative decrease). [88][89][90] However, others have not been able to demonstrate the superiority of polyurethane-cuffed ETTs in reducing microaspiration.…”

Section: Modifiable Risk Factors For Ventilator-associated Pneumonia mentioning

confidence: 99%

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The Vexing Problem of Ventilator-Associated Pneumonia: Observations on Pathophysiology, Public Policy, and Clinical Science

Kallet

2015

Respir Care

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SummaryVentilator-associated pneumonia (VAP) is an acquired infection related primarily to the consequences of prolonged endotracheal intubation. It is considered the most important infectious challenge in the critical care setting. Preventable complications of hospital care are considered an important source of wasted health-care costs believed to consume up to 47% of annual expenditures in the United States. Whether VAP is preventable has become a highly contentious debate since public reporting commenced a decade ago. This selective review focuses on specific aspects of this debate, including the inherent vagaries in the diagnosis of VAP and the marked disparities between VAP rates based on clinical diagnosis versus surveillance data. Also discussed is how this debate has impacted public policy, leading to the new paradigm of ventilator-associated events. The limited ability of artificial airways to prevent microaspiration and biofilm build-up, as well as non-modifiable conditions increasing the risk of VAP, is described in detail. In addition, the origins of the mistaken but widely embraced notion that zero VAP is a realistic achievement are examined.

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Section: Pathophysiology Of Ventilator-associated Pneumoniasupporting

confidence: 58%

Section: Modifiable Risk Factors For Ventilator-associated Pneumonia mentioning

confidence: 99%

The Vexing Problem of Ventilator-Associated Pneumonia: Observations on Pathophysiology, Public Policy, and Clinical Science

Kallet

2015

Respir Care

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“…In particular, the composition of the ETT cuff can favor microaspiration of secretions through folds that develop in the cuff over time (8)(9)(10)(11). Three small RCTs and a longitudinal analysis suggested that use of a polyurethane-cuffed ETT (PUC-ETT) was associated with a reduced incidence of VAP compared with intubation with a standard polyvinylchloride-cuffed ETT (PVC-ETT) (12)(13)(14)(15).…”

mentioning

confidence: 99%

Randomized Pilot Trial of Two Modified Endotracheal Tubes To Prevent Ventilator-associated Pneumonia

et al. 2016

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Rationale: Ventilator-associated pneumonia (VAP) is a prevalent and costly nosocomial infection related to instrumentation of the airway with an endotracheal tube (ETT), enabling microaspiration of contaminated secretions. Modification of the ETT design to reduce microaspiration and/or biofilm formation may play an important role in VAP prevention. However, there is insufficient evidence to provide strong recommendations regarding the use of modified ETT and unaddressed safety concerns.Objectives: We performed a pilot randomized controlled trial comparing two modified ETTs designed specifically to prevent VAP, with the standard ETT, to test the feasibility of and inform planning for a large, pivotal, randomized trial.Methods: This study was conducted with institutional review board approval under exception from informed consent. We randomized in a blinded fashion patients undergoing emergency endotracheal intubation both out of and in hospital to receive one of three different ETT types: (1) a polyurethane-cuffed tube (PUC-ETT), (2) a polyurethane-cuffed tube equipped with a port for continuous aspiration of subglottic secretions (PUC-CASS-ETT), or a (3) standard polyvinylchloride-cuffed tube (PVC-ETT). In addition to investigating feasibility and safety, the study coprimary end points were tracheal bacterial colonization reaching a cfu count .10 6 cfu per milliliter and the incidence of invasively diagnosed VAP. Measurements and Main Results:A total of 102 subjects were randomized and met the eligibility criteria. Randomization procedures performed well and integrity of blinding at randomization was maintained. The majority of intubations occurred in the hospital setting (n = 77), and the remainder occurred out of hospital (n = 25). Compared with the PVC-ETT, there were no significant differences in tracheal colonization for PUC-ETT (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.31-3.09) or for PUC-CASS-ETT (OR, 1.26; 95% CI, 0.42-3.76). There were no differences in the risk of invasively diagnosed VAP (OR, 1.14; 95% CI, 0.21-6.08 for PUC-ETT; OR, 1.47; 95% CI, 0.30-7.10 for PUC-CASS-ETT), or of clinically diagnosed VAP by either clinical signs or chest radiograph criteria. We did not observe unexpected or serious adverse events related to the devices. Conclusions:A randomized trial of ETTs inserted during emergency intubation for the prevention of VAP is feasible and did not appear to carry heightened safety concerns. These preliminary data did not suggest different patterns of tracheal colonization or occurrence of VAP among the study groups.Clinical trial registered with www.clinicaltrials.gov (NCT01744483).

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“…Если же показана общая анес тезия, необходимо изолировать дыхательные пути с помощью эндотрахеальной трубки. Опубликова ны довольно интересные исследования, свиде тельствующие о большей безопасности при ис пользовании трубок с манжетами малого объема и низкого давления [33]. Несмотря на то, что интер вал индукция -интубация короток, необходимо соблюдать следующие условия для предупрежде ния регургитации: а) индукцию нельзя проводить в положении для камнесечения (оно может вызвать дополни тельное повышение внутрижелудочного давления); б) следует избегать давления на живот; в) надо избегать проведения вентиляции под положительным давлением (для того, чтобы избе жать раздувания желудка воздухом); г) необходимо использовать прием Селлика.…”

Section: гиперэргический аспирационный пневмонитunclassified

Hyperergic Aspiration Pneumonitis (Mendelson Syndrome)

Shifman¹

2006

rmt

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A low-volume, low-pressure tracheal tube cuff reduces pulmonary aspiration*

Cited by 125 publications

References 33 publications

The Vexing Problem of Ventilator-Associated Pneumonia: Observations on Pathophysiology, Public Policy, and Clinical Science

The Vexing Problem of Ventilator-Associated Pneumonia: Observations on Pathophysiology, Public Policy, and Clinical Science

Randomized Pilot Trial of Two Modified Endotracheal Tubes To Prevent Ventilator-associated Pneumonia

Hyperergic Aspiration Pneumonitis (Mendelson Syndrome)

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