Gel Lubrication of the Tracheal Tube Cuff Reduces Pulmonary Aspiration

Blunt, Mark; Young, Peter; Patil, Anita; Haddock, Alan

doi:10.1097/00000542-200108000-00019

Cited by 84 publications

(73 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Tube cuff lubrication has been used by several investigators during in vitro trials to imitate a close contact of the cuff surface with the tracheal mucosa and filling of microchannels (longitudinal folds) with mucosal fluid. In these models, cuff lubrication reduced or prevented fluid leakage past the cuff, results similar to those of our study [11,12]. The strength of the present study is the finding that cuff lubrication prevented fluid leakage even in those HVLP cuffs that have poor sealing characteristics.…”

Section: Discussionsupporting

confidence: 87%

Tracheal fluid leakage in benchtop trials: comparison of static versus dynamic ventilation model with and without lubrication

et al. 2010

View full text Add to dashboard Cite

Purpose Longitudinal folds in tracheal tube (TT) cuffs cause leakage of pooled secretions past the tube cuff, and the most common in vitro method to test the efficacy of a new tube is a benchtop model using an artificial rigid trachea. This study compared the potential of a static and dynamic ventilation benchtop model and cuff lubrication in testing the tracheal sealing properties of a given TT cuff. Methods Static trial Six brands of 7.5 mm internal diameter (ID) cuffed TT (n = 8) with high volume-low pressure cuffs were inflated in an artificial trachea (18 mm ID) without and with lubrication. Dynamic trial The same tube cuffs, without lubrication, were subjected to positive pressure ventilation (PPV) ? positive end-expiratory pressure (PEEP) of 5cmH 2 O or to PPV alone (without PEEP) or to PEEP alone (without PPV). Clear water (5 ml) was placed above the tube cuff, and fluid leakage (ml) was measured up to 60 min. Results Gel lubrication, PEEP alone and PPV ? PEEP completely prevented fluid leakage across the tube cuffs in all six TT brands tested within 60 min when compared to the static unlubricated model (0% leak versus 100% leak; P \ 0.01). Fluid leakage in the static unlubricated model and the PPV group was 1.38-4.76 ml and 0.23-4.47 ml, respectively. Conclusion Gel lubrication, PEEP alone, and PPV ? PEEP in the benchtop model had a much stronger protective effect than PPV alone on fluid leakage. Studies testing the fluid sealing efficiency of tube cuffs might be more conclusive in a static benchtop model without lubrication than in a dynamic model.

show abstract

Section: Discussionsupporting

confidence: 87%

Tracheal fluid leakage in benchtop trials: comparison of static versus dynamic ventilation model with and without lubrication

et al. 2010

View full text Add to dashboard Cite

show abstract

“…[4][5][6] Lubrication of the tracheal tube may be useful to minimize the mucosal injury by facilitating its passage through the pharynx and to reduce pulmonary aspiration. 7 Additionally, topical steroids as lubricating agents are good options for POST. This is a reasonable strategy to provide targeted therapy because local irritation and inflammation of the tracheal mucosa may be the primary causes of POST.…”

Section: Résumémentioning

confidence: 99%

Application of triamcinolone acetonide paste to the endotracheal tube reduces postoperative sore throat: a randomized controlled trial

Park

Kim

Lee

et al. 2011

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

“…Adding a layer of water-soluble lubricant on the ETT cuff can decrease the amount of fluid that flows across the cuff but this effect only lasts about 24-h in clinical practice [13]. Another approach is to make the cuff out of highly distensible Lycra instead of polyvinylchloride or polyurethane [14].…”

mentioning

confidence: 99%

Beware the siren’s song of novel endotracheal tube designs

Branson

2017

Intensive Care Med

View full text Add to dashboard Cite

Ventilator-associated pneumonia (VAP) remains a common and morbid complication of mechanical ventilation. Notwithstanding hospitals' and device manufacturers' extensive efforts to prevent this condition, clinical audits suggest VAP rates have changed little over the past decade [1]. VAP's persistence compels us to redouble our efforts to find better ways to prevent this condition. Prevention efforts to date can be divided into two major domains: (1) technical innovations to reduce biofilm accumulation and passage of secretions around the endotracheal tube cuff, and (2) adaptive work to minimize duration of mechanical ventilation and thus time at risk for VAP. Examples of technical innovations include antiseptic-coatings, subglottic secretion drainage, tracheal cuff pressure maintenance systems, and novel endotracheal tube cuff designs. Examples of adaptive efforts include minimizing sedation, increasing the use of spontaneous awakening and spontaneous breathing trials, and early mobilization programs.Technical innovations have followed a familiar pattern. Initially promising bench studies have given way to disappointing clinical trials [2]. Antiseptic coating decreased endotracheal tube colonization rates in sheep but did not decrease duration of mechanical ventilation or mortality rates in humans [3,4]. Subglottic secretion drainage (SSD) reduces VAP diagnoses but does not reduce time to extubation or mortality rates [5]. Persistently low tracheal cuff pressures are a risk factor for VAP but automated cuff pressure control devices have yielded conflicting results [6,7]. Tapered and polyurethane cuffs decrease (but do not eliminate) leakage around the cuff in bench studies but have not reduced VAP rates in randomized controlled trials [8,9].A recent article by Jaillette and colleagues in Intensive Care Medicine continues this disappointing pattern [10]. The investigators compared conical polyvinylchloride cuffs to standard-shaped cuffs on aspiration rates, VAP, and ventilator-associated events (VAE), and assayed endotracheal tube aspirates for pepsin and alpha-amylase. Pepsin was considered a surrogate marker for aspirating gastric fluids and alpha-amylase a surrogate marker for aspirating oropharyngeal fluids. The investigators found no difference in the frequency of positive pepsin assays (54% of tapered cuff samples vs 51% of standard cuff samples) or positive alpha-amylase assays (77 vs 69%). Likewise, there were no differences in VAP or VAE rates, ventilator-free days, ICU length-of-stay, or ICU mortality. This multicenter, cluster, randomized cross-over trial has a number of strengths. The primary outcome was positive pepsin assays, but to their credit the authors also reported on VAP, VAE, ventilator-free days, ICU lengthof-stay, and ICU mortality. Including these secondary outcomes provides useful clinical context to interpret the pepsin and alpha-amylase assays, especially since they are imperfect markers for aspiration [11].A number of important observations and questions arise from the study. First, i...

show abstract

Gel Lubrication of the Tracheal Tube Cuff Reduces Pulmonary Aspiration

Abstract: Cuff lubrication with a water-soluble gel reduces pulmonary aspiration in anesthetized patients. In the critically ill patient with a tracheostomy the protective effect is lost after 24-120 h.

Cited by 84 publications

References 23 publications

Tracheal fluid leakage in benchtop trials: comparison of static versus dynamic ventilation model with and without lubrication

Tracheal fluid leakage in benchtop trials: comparison of static versus dynamic ventilation model with and without lubrication

Application of triamcinolone acetonide paste to the endotracheal tube reduces postoperative sore throat: a randomized controlled trial

Beware the siren’s song of novel endotracheal tube designs

Contact Info

Product

Resources

About