Airway injury from the presence of endotracheal tubes and the association with subglottic secretion drainage: a prospective observational study

Sibley, Stephanie; Ball, Ian; D’Arsigny, Christine L.; Drover, John W.; Erb, Jason W.; Galvin, I.; Howes, Daniel; Ilan, Roy; Messenger, David; Moffatt, Susan L.; Parker, Christopher M.; Ridi, Stacy; Muscedere, John

doi:10.1007/s12630-022-02333-x

Cited by 3 publications

(1 citation statement)

References 27 publications

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“…In the present study, the cuff pressure was set higher than the clinical standard to prevent a gap between the cylinder and cuff, and a rigid transparent cylinder was employed as a substitute for the trachea, which did not suffer any deformation from suction pressure during side-port drainage. However, in the clinical setting, there is a warning about the potential risks associated with suction pressure, such as traction on the tracheal mucosa leading to blockage of the laterally situated suction holes or tracheal mucosal injury, as well as the risk of ulceration due to contact between the additional tube of the suction port and the tracheal mucosa [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Differences in residual volume above different tracheostomy tube cuffs depending on tube structure, tube tilt angle, and liquid viscosity

Katsuno,

Ueha,

Fujisaki

et al. 2023

Eur Arch Otorhinolaryngol

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Introduction Proper management of aspirated material above the tracheostomy tube cuff is crucial to prevent complications, such as aspiration pneumonia. This study aimed to thoroughly examine the effects of aspirated liquid viscosity, suction port positioning, and tube tilt angle on residual volume above the cuff (RVAC). Methods Five types of tracheostomy tubes (approximately 9 mm outer diameter) were placed through a transparent cylinder with an inner diameter of 18 mm. The cuff was inflated to completely seal the interior of the cylinder. Four liquids with different viscosities were poured onto the cuff, and the liquid above the cuff was suctioned from the side port. The cylinder was angled at 90° and 20°, and each test was performed thrice to determine the average RVAC. Results After side-port suctioning, some liquid residue was observed on the cuff of all tracheostomy tubes. The RVAC increased with higher liquid viscosity. The tubes with a longer distance from the suction port opening to the cuff top exhibited more RVAC. Moreover, the RVAC was almost the same regardless of the cylinder angle for tubes with a suction port on the lateral side. However, tubes with backside ports showed a decreased RVAC with cylinder tilt. Conclusions This study underscores the persistence of residual material on cuffed tracheostomy tubes even with regular subglottic secretion drainage. This emphasizes the need for specialized tracheostomy tube development aimed at reducing post-suction RVAC. Improved designs can potentially minimize complications associated with residue accumulation.

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Section: Discussionmentioning

confidence: 99%