Tapered-cuff versus cylindrical-cuff tracheal tube in preventing fluid leak: An in-vitro experimental study

Khashaba, Shehab; Chaari, Anis; Uddin, Fares; Hamamah, Dalya; Ismail, Mohamed; Tierney, Eamon; Casey, William

doi:10.1016/j.tacc.2018.09.004

Cited by 3 publications

(3 citation statements)

References 20 publications

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“…In the study, the authors used endotracheal/tracheotomy tubes with a taper-shaped cuff and the subglottic suction system. In in vitro studies [19,20] and in an ex vivo animal study [26], taper-shaped cuffs provided better sealing properties than cylindrical or spherical ones. Therefore, the use of an artificial airway with a taper-shaped cuff should be effective in the prevention of VAP by limiting the micro-aspiration of infected secretions to the lower respiratory tract.…”

Section: Discussionmentioning

confidence: 94%

“…It also appears that subglottic secretion suction may contribute to the reduction not only of the total incidence of VAP, but also of early VAP [17] and mortality [18]. The authors of in vitro experimental studies [19,20] suggested that the shape of the artificial airway cuff may also influence the amount of micro-aspiration content. However, a meta-analysis of randomized clinical trials conducted by Huang et al [21] did not confirm the advantage of the tapered-cuff endotracheal tube over the standard-cuff endotracheal tube in reducing VAP and ICU mortality.…”

Section: Introductionmentioning

confidence: 99%

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Automatic Continuous Control of Cuff Pressure and Subglottic Secretion Suction Used Together to Prevent Pneumonia in Ventilated Patients—A Retrospective and Prospective Cohort Study

Tomaszek

Pawlik

Mazurek

et al. 2021

JCM

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The ventilator bundle consists of multiple methods to reduce ventilator-associated pneumonia (VAP) rates in Intensive Care Units (ICU). The aim of the study was to evaluate how the continuous automatic pressure control in tapered cuffs of endotracheal/tracheostomy tubes applied along with continuous automatic subglottic secretion suction affect the incidence of VAP. In the prospective cohort (n = 198), the standard VAP bundle was modified by continuous automatic pressure control in taper-shaped cuff of endotracheal/tracheostomy tubes and subglottic secretion suction. VAP incidence, time to VAP onset, invasive mechanical ventilation days/free days, length of ICU stay, ICU mortality, and multidrug-resistant bacteria were assessed and compared to the retrospective cohort (n = 173) with the standard bundle (intermittent cuff pressure of standard cuff, lack of subglottic secretion suction). A smaller incidence of VAP (9.6% vs. 19.1%) and early onset VAP (1.5% vs. 8.1%) was found in the prospective compared to the retrospective cohort (p < 0.01). Patients in the prospective cohort were less likely to develop VAP (RR = 0.50; 95% CI: 0.29 to 0.85) and early-onset VAP (RR = 0.19; 95% CI: 0.05 to 0.64) and had longer time to onset VAP (median 9 vs. 5 days; p = 0.03). There was no significant difference (p > 0.05) between both cohorts in terms of invasive mechanical ventilation days/free days, length of ICU stay, ICU mortality and multidrug-resistant bacteria. Modification of the bundle for prevention of VAP can reduce early-onset VAP and total incidence of VAP and delay the time of VAP occurrence.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Automatic Continuous Control of Cuff Pressure and Subglottic Secretion Suction Used Together to Prevent Pneumonia in Ventilated Patients—A Retrospective and Prospective Cohort Study

Tomaszek

Pawlik

Mazurek

et al. 2021

JCM

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“…In another study, it was found that ET with a conical cuff caused significantly less gastric secretion leakage compared to cylindrical cuffed tubes and was more effective in preventing the development of VAP (32,33) . In a study conducted in patients undergoing cervical surgery, it was found that the ETCP value measured in the conical cuff changed much less frequently during surgery and the cuff pressure was lower than in cylindrical cuffed endotracheal tubes (34) .…”

Section: Discussionmentioning

confidence: 99%

Determination of Factors Affecting Endotracheal Tube Cuff Pressure in Adult Patients in Intensive Care Unit

Kebapçı¹

2022

JAREN

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Aim: This study aimed to determine factors that affect endotracheal tube cuff pressure (ETCP) in adult patients under mechanical ventilation support in intensive care unit. Background: Maintaining the ETCP within safe ranges, which ensures airway patency and provides positive pressure ventilation, is a complex circumstance due to many factors. Although there are recommendations for the prevention of excessive or insufficient ETCP, there is still no consensus based on affecting factors. Design: The study was designed as a cross sectional, descriptive, and correlational study. A total of 67 patients who met the criteria of the study were included in the study, and 264 ETCP measurements were performed during their hospitalization in the intensive care unit. Results: The mean age was 70.56.7% of participants were men, and 21.4% of them were admitted to the ICU after surgical intervention. The mean ETCP value was 28.5cmHg (5-127 cmHg). 55.7% of measurements were hyperinflation, 58.71% of patients had orotracheal tube, %84.4 of endotracheal tubes had standard circular cuff and mean tube size number was 8.0. Mean head of bed degree was 25 degree and 61.7% of patient was in supine position. In the regression analysis, the variables affecting the nursing image age, body mass index (kg/m2), type of tracheal tube, shape of cuff, size of tube and head of bed degree (p<0.05). Conclusion:The results of the study show that the ETCP values were mostly high and were affected by both patient-specific factors and endotracheal tube-related factors. It is recommended that standard protocols should be developed to manage ETCP and monitor ETCP by intensive care nurses with frequent intervals, considering patient-specific variables and endotracheal tube characteristics, since potentially undesirable elevations in the patient's ETCP values are common.

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Editorial comment: This months articles focus on airway management

Theiler

2019

Trends in Anaesthesia and Critical Care

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Tapered-cuff versus cylindrical-cuff tracheal tube in preventing fluid leak: An in-vitro experimental study

Cited by 3 publications

References 20 publications

Automatic Continuous Control of Cuff Pressure and Subglottic Secretion Suction Used Together to Prevent Pneumonia in Ventilated Patients—A Retrospective and Prospective Cohort Study

Automatic Continuous Control of Cuff Pressure and Subglottic Secretion Suction Used Together to Prevent Pneumonia in Ventilated Patients—A Retrospective and Prospective Cohort Study

Determination of Factors Affecting Endotracheal Tube Cuff Pressure in Adult Patients in Intensive Care Unit

Editorial comment: This months articles focus on airway management

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