Effects of lubrication on air-sealing performance of a pediatric cuffed tracheal tube

Abstract

BackgroundLubrication of cuffed tracheal tubes (CTTs) reduces liquid leakage. However, it is not clear how cuff lubrication influences air leakage. We aimed to test the hypothesis that pretreatment with K-Y jelly, a water-soluble lubricant, would improve the air-sealing performance of pediatric CTTs in a model study.MethodsWe placed Parker Flex-Tip™ CTT with 4.0- and 5.0-mm internal diameter (ID) into a tracheal model with 9- and 12-mm ID. The tracheal model was connected to a test lung ventilated in pressure control mode. We compared three cuff lubrication conditions: none (N), water (W), and K-Y jelly (KY). We measured the leak airway pressure (LAWP), defined as the lowest peak airway pressure (PAWP) at which leakage was detected, with the fixed cuff pressure (CP) at 20 cmH2O and varied PAWP. We also measured the leak CP (LCP), defined as the highest CP at which leakage was detected, with fixed PAWP at 25 cmH2O and varied CP. We confirmed air leakage when an apparent elevation of oxygen concentration was detected above the cuff after changing the inspiratory gas from air to oxygen.ResultsFor both 4.0-mm ID and 5.0-mm ID endotracheal tubes, the KY group showed significantly higher LAWP and lower LCP than the other two groups. For the 4.0-mm ID, median values and ranges of LAWP and LCP were K-Y group: 25 (25) and 15 (15); N group: 5 (5) and 35 (35): and W group: 5 (5) and 35 (15–35) cmH2O. For the 5.0-mm ID, median values and ranges of LAWP and LCP were K-Y group: 25 (15–25) and 15 (15–35); N group: 5 (5) and 35 (35); and W group: 5 (5) and 35 (15–35) cmH2O. Water application did not change these outcomes compared with the N group.ConclusionPre-treatment of the cuff with K-Y jelly significantly improved the air-sealing performance of a pediatric CTT in our model study.

K-Y™ jelly inhibits increase in endotracheal tube cuff pressure during nitrous oxide exposure in vitro

“…1 ). For lubrication, 1.5 g of K-Y™ Jelly was used, as described in a prior study [ 9 ]. In the lubricated cuff group, after weighing out 1.5 g of K-Y™ Jelly on a pre-weighed plastic dish, ETT cuffs were fully lubricated by dipping and rotating ETT cuffs in the K-Y jelly.…”

“…In the lubricated cuff group, after weighing out 1.5 g of K-Y™ Jelly on a pre-weighed plastic dish, ETT cuffs were fully lubricated by dipping and rotating ETT cuffs in the K-Y jelly. A pediatric trachea model, which consisted of an acrylic cylinder with an ID of 12 mm, was used to simulate the trachea of an approximately 8-year-old patient [ 9 ]. An acrylic cylinder has been used as a trachea model in prior studies [ 9 , 11 ].…”

“…A pediatric trachea model, which consisted of an acrylic cylinder with an ID of 12 mm, was used to simulate the trachea of an approximately 8-year-old patient [ 9 ]. An acrylic cylinder has been used as a trachea model in prior studies [ 9 , 11 ]. The trachea model was fixed horizontally and intubated with the ETTs with or without lubrication.…”

“…We reported in our earlier study that lubrication with K-Y™ Jelly improves air sealing of pediatric ETT cuffs [ 9 ]. For this reason, we were concerned that, in the absence of lubrication, ventilation may induce air leakage.…”

“…It has been well documented in laboratory and clinical studies that lubrication of ETT cuffs reduces liquid and air leakage around the cuffs [ 6 – 9 ]. However, the effect of lubrication on changes in the ETT cuff pressure during N 2 O exposure has not been studied.…”