Assessment of intraoperative microaspiration: does a modified cuff shape improve sealing?

Abstract

Short-term use of tapered-shaped polyvinylchloride cuffs in surgical patients results in more effective sealing of the tracheal lumen in comparison with a traditional barrel-shaped polyvinylchloride cuffs. Further evaluation is needed to determine whether a reduction in post-operative pneumonia can be demonstrated when these cuffs are used.

Comparison of the cuff pressure of a TaperGuard endotracheal tube and a cylindrical endotracheal tube after lateral rotation of head during middle ear surgery

“…It was demonstrated that a TaperGuard ETT is more effective for prevention of microaspiration and pneumonia during mechanical ventilation than a cylindrical ETT. [9,21] …”

A 2015 Update on Ventilator-Associated Pneumonia: New Insights on Its Prevention, Diagnosis, and Treatment

“…ETTs are associated with significant impairment of mucociliary clearance of secretions, the formation of bacterial biofilms upon the ETT polymer, microaspiration and leakage of oropharyngeal secretions around the inflated ETT cuff (Fig. 1) [10][11][12]. These are exacerbated in the context of positive pressure ventilation, which combines with gravity to move secretions and microorganisms into the distal respiratory tract.…”

Performance of the PneuX System: A Bench Study Comparison With 4 Other Endotracheal Tube Cuffs

“…1,2,5,6 Devices that continuously regulate intracuff pressure facilitate cuff pressure management [7][8][9] ; however, other factors, including cuff design, also significantly affect secretion leakage. 7,[10][11][12][13][14][15][16] The primary mechanism of microaspiration is believed to be movement through longitudinal folds in the material of the inflated cuff. 11,13,[17][18][19] These folds are an unavoidable consequence of the physical characteristics of modern high-volume low-pressure (HVLP) cuffs, being effectively inelastic with a diameter exceeding that of the trachea.…”