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

Chenelle, Christopher T; Itagaki, Taiga; Fisher, Daniel F.; Kacmarek, Robert M.

doi:10.4187/respcare.04996

Cited by 17 publications

(25 citation statements)

References 40 publications

(102 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results replicate previous in vitro studies which demonstrate no leakage past the cuff for the PneuX ETT and superior performance when compared to other ETT examined [10, 36]. Our findings are also supported by a recent publication by Chenelle et al, which demonstrated leakage in a different bench model [37]. In their study, Chenelle et al, showed leakage occurred with all HVLP cuffs tested and was prevented by the PneuX cuff [37].…”

Section: Discussionsupporting

confidence: 91%

“…Our findings are also supported by a recent publication by Chenelle et al, which demonstrated leakage in a different bench model [37]. In their study, Chenelle et al, showed leakage occurred with all HVLP cuffs tested and was prevented by the PneuX cuff [37]. Our study confirms and builds on this data, by testing all the SSD ETT currently available and also examines the quantification of the bacterial load which the lungs may be exposed to.…”

Section: Discussionsupporting

confidence: 90%

“…Our study confirms and builds on this data, by testing all the SSD ETT currently available and also examines the quantification of the bacterial load which the lungs may be exposed to. Commonly, in vitro studies have used water to demonstrate leakage past the cuff [10, 12, 32, 37]. Our study is novel in its use of a microbial solution, which was used to simulate the presence of pathogenic organisms commonly found in the subglottic space.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Endotracheal tubes and fluid aspiration: an in vitro evaluation of new cuff technologies

et al. 2017

View full text Add to dashboard Cite

BackgroundAspiration of subglottic secretions past the endotracheal tube (ETT) cuff is a prerequisite for developing ventilator-associated pneumonia (VAP). Subglottic secretion drainage (SSD) ETTs reduce aspiration of subglottic secretions and have demonstrated lower VAP rates. We compared the performance of seven SSD ETTs against a non-SSD ETT in preventing aspiration below inflated cuffs.MethodsETTs were positioned vertically in 2 cm diameter cylinders. Four ml of a standard microbial suspension was added above inflated cuffs. After 1 h, aspiration was measured and ETTs demonstrating no leakage were subjected to rotational movement and evaluation over 24 h. Collected aspirated fluid was used to inoculate agar media and incubated aerobically at 37 °C for 24 h. The aspiration rate, volume and number of microorganisms that leaked past the cuff was measured. Experiments were repeated (×10) for each type of ETT, with new ETTs used for each repeat. Best performing ETTs were then tested in five different cylinder diameters (1.6, 1.8, 2.0, 2.2 and 2.4 cm). Experiments were repeated as above using sterile water. Volume and time taken for aspiration past the cuff was measured. Experiments were repeated (×10) for each type of ETT. Results were analysed using non-parametric tests for repeated measures.ResultsThe PneuX ETT prevented aspiration past the cuff in all experiments. All other ETTs allowed aspiration, with considerable variability in performance. The PneuX ETT was statistically superior in reducing aspiration compared to the SealGuard (p < 0.009), KimVent (p < 0.002), TaperGuard (p < 0.004), Lanz (p < 0.001), ISIS (p < 0.001), SACETT (p < 0.001) and Soft Seal (p < 0.001) ETTs. Of the 4 ETTs tested in differing cylinder sizes, the PneuX significantly reduced aspiration across the range of diameters compared to the SealGuard (p < 0.0001), TaperGuard (p < 0.0001) and KimVent (p < 0.0001) ETTs.ConclusionsETTs showed substantial variation in fluid aspiration, relating to cuff material and design. Variability in performance was likely due to the random manner in which involutional folds form in the inflated ETT cuff. The PneuX ETT was the only ETT able to consistently prevent aspiration past the cuff in all experiments.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Endotracheal tubes and fluid aspiration: an in vitro evaluation of new cuff technologies

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Polyvinylchloride or polyurethane are relatively inelastic thus cuffs made with these materials are designed to be larger than the trachea to ensure that they obstruct the entire trachea. The large size of the cuffs, however, means that it is inevitable that they will form micro-folds against the trachea that allow fluids to flow into the lungs regardless of cuff shape [12].…”

mentioning

confidence: 99%

“…This cuffless endotracheal tube conforms to the opening of the glottis and prevents leakage of secretions in intubated sheep. A final option is to replace standard cuff materials with a thick silicon cuff [12]. These cuffs require high intra-cuff pressure in order to overcome silicone elasticity but still transmit low tracheal wall pressures.…”

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

Accuracy of pilot balloon palpation for cuff pressure assessment in small versus large sized tubes: a prospective non-randomized observational study

Ban

Kim

et al. 2023

Sci Rep

View full text Add to dashboard Cite

Pilot balloon palpation is still a commonly used method to evaluate cuff pressure of the endotracheal tube after intubation. This study determined whether the size of the tracheal tube influenced the accuracy of pilot balloon palpation. A prospective observational analysis of 208 patients intubated with an endotracheal tube of internal diameter (ID) 6.0 or 8.0 was conducted. An anesthesiologist judged the cuff pressure by manual pilot balloon palpation, and then measured the cuff pressure with a pressure gauge. Cuff pressure exceeding 20–30 cmH2O was defined as false recognition. The intracuff pressure was significantly higher in ID 6.0 tube than in the ID 8.0 tube (41.9 ± 18.8 cmH2O vs. 30.3 ± 11.9 cmH2O, p < 0.001). The number of patients that were mistakenly perceived to have appropriate cuff pressure by pilot balloon palpation was significantly higher in the ID 6.0 group compared to the ID 8.0 group (85 (81.7%) vs. 64 (61.5%), p = 0.001). Therefore, a smaller tube size may further increase risk of inaccurate measurement by pilot balloon palpation and although pressure gauge is recommended for all sizes to maximize accuracy, groups with increased risk factors should be targeted for standardized use of the pressure gauge.

show abstract

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

Abstract: The PneuX cuff generally exerted acceptable tracheal wall pressure, but the tracheal wall pressure monitor allowed pressures exceeding 30 cm HO in some trials and was the only ETT to prevent leak in all tests. For HVLP cuffs, leak was reduced by PU and PEEP and eliminated by lubrication.

Cited by 17 publications

References 40 publications

Endotracheal tubes and fluid aspiration: an in vitro evaluation of new cuff technologies

Endotracheal tubes and fluid aspiration: an in vitro evaluation of new cuff technologies

Beware the siren’s song of novel endotracheal tube designs

Accuracy of pilot balloon palpation for cuff pressure assessment in small versus large sized tubes: a prospective non-randomized observational study

Contact Info

Product

Resources

About