Variables affecting leakage past endotracheal tube cuffs: a bench study

Abstract

Cuff leakage varies greatly among ETT types and is affected by cuff pressure, PEEP, PIP, and mode.

Evaluation of an Automated Endotracheal Tube Cuff Controller During Simulated Mechanical Ventilation

“…A trachea model, as described by Pitts et al, 19 consisting of silicon tubing (28-cm length and 2.3-cm internal diameter) was used for this study. The trachea model was lightly clamped in a stationary vertical position, intubated without lubrication, and connected to a test lung.…”

Novel Endotracheal Tube Cuffs: Improving the Seal as a Barrier to Leakage

“…[8][9][10]13 However, the study's measurement conditions did not include PEEP or mechanical ventilation, so the benefit of the new cuff in the presence of positive-pressure ventilation is unknown, given that PEEP influences the rate of fluid leak. 9,[12][13][14]16 The selection of a round, inflexible acrylic tube for a trachea model, although common in the literature, 3,8,11 may not translate in vivo, because the most common tracheal cross-sectional shape is an ellipse. 6 Young et al reported that, with an acrylic tube as the trachea model, all the endotracheal tube cuffs tested demonstrated leak, but only 45% of the tubes had a leak when examined in a porcine trachea.…”

“…2,[7][8][9][10][11] The flow of secretions past the cuff is determined by the height of the column above the cuff, the angle of inclination, the cuff inflation pressure, and the tracheal pressure applied by the ventilator. 9,[12][13][14] The addition of PEEP has been shown, both in vivo and in vitro, to counterbalance this hydraulic force and to limit the leakage past the cuff. 9,13,14 The endotracheal tube and cuff were recently examined for their contributions to VAP.…”

“…9,[12][13][14] The addition of PEEP has been shown, both in vivo and in vitro, to counterbalance this hydraulic force and to limit the leakage past the cuff. 9,13,14 The endotracheal tube and cuff were recently examined for their contributions to VAP. Several studies looked at cuff design and how it affects microaspiration under various conditions.…”

“…Several studies looked at cuff design and how it affects microaspiration under various conditions. 2,[8][9][10][11] Other studies have evaluated antimicrobial properties of new materials incorporated into the endotracheal tube design. 7 Although a silver-impregnated endotracheal tube may reduce the risk for VAP, 7 the costeffectiveness of this device is yet to be determined.…”