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

Abstract

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.

Comparison of a Novel Lycra Endotracheal Tube Cuff to Standard Polyvinyl Chloride Cuff and Polyurethane Cuff for Fluid Leak Prevention

“…Another possible bias is that a human trachea is neither cylindrical nor rigid, so our results cannot immediately be transferred to clinical practice The lack of water leakage we observed for 24 hours may not reflect clinical performance, since in our setup the mock trachea and ETT remained still, whereas in vivo the cuff moves inside the trachea when the patient's neck bends. 10 Though Lycra is highly distensible, it needs some pressure to be inflated and stretched (about 40 cm H 2 O to obtain a diameter 1.8 times the baseline); part of the intracuff pressure is spent to keep the cuff inflated and part is spent on the tracheal wall, depending on the size of the trachea. When the Lycra cuff is inflated in a trachea with a diameter close to the diameter of the cuff, the transmitted pressure is about 5 cm H 2 O lower than the intracuff pressure, but with a trachea 5 mm wider the difference between intracuff pressure and transmitted pressure reaches 15 cm H 2 O.…”

Tracheal fluid leakage in benchtop trials: comparison of static versus dynamic ventilation model with and without lubrication

“…The most common and convenient in vitro method to test the efficacy of a new tube cuff in preventing fluid leakage is a benchtop model using an artificial rigid trachea. Investigators and reviewers are often keen to impose more stringent testing conditions, such as dynamic ventilation settings including positive end-expiratory pressure (PEEP) and/or adding lubrication on the cuff wall [5][6][7][8][9][10].…”

Ventilator‐associated pneumoniaDiagnosis, pathogenesis and prevention

“…Dye placed in the subglottic space will pass along folds within the cuff wall to the trachea in 87-100% of cases [51][52][53]. In a ventilatory model [54] and in the cadaveric trachea [55], the rate of leakage along the cuff folds was found to be of the order of magnitude of millilitres per minute and leakage occurred despite increasing the cuff pressure above normal (Fig.…”

“…6). The cuff is used in combination with a constant-pressure inflation device and has been shown to reduce the aspiration of dye placed in the subglottis from 87% with a conventional HVLP cuff to 0% with the PLC [52]. The 'no pressure' laryngeal seal design by Kolobow and co-workers has been evaluated in sheep.…”