New Ultrathin-walled Endotracheal Tube with a Novel Laryngeal Seal Design

Reali-Forster, Chiara; Kolobow, Theodor; Giacomini, Matteo; Hayashi, Tomayoshi; Horiba, Koji; Ferrans, Víctor J.

doi:10.1097/00000542-199601000-00019

Cited by 51 publications

(27 citation statements)

References 14 publications

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“…21 Gills have been shown to form an effective seal (> 40 cm H 2 O) with the glottis when incorporated into tracheal tube design. 22 We found that flexible lightwand-guided intubation with the PAX had a first attempt insertion success rate without adjusting maneuvers of 60%, a first attempt insertion success rate with adjusting maneuvers of 79% and an overall intubation success rate of 82%. This compares with a first attempt insertion success rate without adjusting maneuvers of 62%, a first attempt insertion success rate with adjusting maneuvers of 92% and overall intubation success rate of 100% for flexible lightwand-guided intubation with the intubating laryngeal mask airway.…”

Section: Me Et Th Ho Od Ds Smentioning

confidence: 76%

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Le PAxpress™ est un appareil de ventilation efficace, mais présente un taux d’échec de 18 % pour l’intubation trachéale sous guidage lumineux flexible chez les patients anesthésiés paralysés

Dimitriou

Voyagis

Iatrou

et al. 2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : The PAxpress™ is a new, single-use, extraglottic airway device. We evaluate: 1) insertion success rates; 2) airway sealing pressure, ventilatory capability and calculated mucosal pressures (in vitro minus in vivo intracuff pressure) at 30-60 mL cuff inflation volume; 3) the feasibility of lightwand-guided tracheal intubation; and 4) the incidence of mucosal trauma.M Me et th ho od ds s: : Ninety anesthetized, paralyzed adults were studied. Airway management was by senior anesthesiologists with no prior experience with the PAX, but considerable experience with extraglottic airway devices and the flexible-lightwand.

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Section: Me Et Th Ho Od Ds Smentioning

confidence: 76%

“…10 The efficacy of seal (25-35 cm H 2 O) was higher than the cuffed oropharyngeal airway (16)(17)(18)(19)(20)(21)(22) and Laryngeal Tube Airway™ (30 cm H 2 O). 9 We found that inflating the cuff from 30 to 60 mL improved the seal from 26 to 35 cm H 2 O.…”

Section: Me Et Th Ho Od Ds Smentioning

confidence: 98%

Le PAxpress™ est un appareil de ventilation efficace, mais présente un taux d’échec de 18 % pour l’intubation trachéale sous guidage lumineux flexible chez les patients anesthésiés paralysés

Dimitriou

Voyagis

Iatrou

et al. 2003

Can J Anesth/J Can Anesth

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“…This tube appears to prevent the passage of oropharyngeal fluid into the lungs in sheep, using methylene blue placed in the oropharynx as a marker [12].…”

Section: Discussionmentioning

confidence: 99%

Prevention of tracheal aspiration using the pressure‐limited tracheal tube cuff

Young¹,

Basson

Hamilton³

et al. 1999

Anaesthesia

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SummaryA new design of tracheal tube cuff, the pressure-limited cuff, used with a constant-pressure inflation system, was compared with a high-volume low-pressure cuffed tracheal tube for leakage of dye placed in the subglottic space into the trachea. Patients requiring ventilation on the intensive care unit were randomly allocated into two groups, one for each type of cuff, and blue food dye was instilled daily via a fine catheter above the cuff into the subglottic space. There were eight patients in the high-volume low-pressure group and seven in the pressure-limited cuff group. Dye leaked into the trachea in seven (87%) of the high-volume low-pressure group compared with none (0%) of the pressure-limited cuff group (p`0.01). This study demonstrates that the pressurelimited cuffed tracheal tube, in combination with a constant-pressure inflation device, prevents leakage of fluid into the lungs that occurs with high-volume low-pressure cuffs in the critically ill, intubated patient.

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“…This dual-cuff technology allows the rubber outer cuff to adhere firmly to the tracheal wall while avoiding compression of the mucosa. A fourth option is to replace the standard cuff with several ring-shaped disks ("gills") made of thin polyurethane film (0.025-0.075 mm thick) [16]. This cuffless endotracheal tube conforms to the opening of the glottis and prevents leakage of secretions in intubated sheep.…”

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confidence: 99%

Beware the siren’s song of novel endotracheal tube designs

Branson

2017

Intensive Care Med

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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...

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New Ultrathin-walled Endotracheal Tube with a Novel Laryngeal Seal Design

Abstract: The novel, no-pressure seal design of the new ETT is highly effective in preventing air leak and aspiration. It causes no significant tracheal injury.

Cited by 51 publications

References 14 publications

Le PAxpress™ est un appareil de ventilation efficace, mais présente un taux d’échec de 18 % pour l’intubation trachéale sous guidage lumineux flexible chez les patients anesthésiés paralysés

Le PAxpress™ est un appareil de ventilation efficace, mais présente un taux d’échec de 18 % pour l’intubation trachéale sous guidage lumineux flexible chez les patients anesthésiés paralysés

Prevention of tracheal aspiration using the pressure‐limited tracheal tube cuff

Beware the siren’s song of novel endotracheal tube designs

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