The Prevention of Pulmonary Aspiration with Control of Tracheal Wall Pressure Using a Silicone Cuff

Abstract

A prospective open randomized controlled study was performed to assess the ability of Euromedical ILM endotracheal tube cuff (silicone cuff) to prevent pulmonary aspiration The inflation characteristics of this silicone cuff enables the control of tracheal wall pressure. The silicone cuffed tube was shortened and an adjustable flange was used to convert it to a cuffed tracheostomy tube. Twelve patients requiring a tracheostomy on a four-bed intensive care unit (ICU) in a district general hospital received either a silicone or a Shiley cuffed tracheostomy tube. Tracheal wall pressures of both cuffs were maintained at 30 cm H 2 O with a constant pressure inflation device. Blue food dye was instilled once daily into the subglottic space through a fine catheter above the cuff. There were six patients in the Shiley group and six patients in the silicone cuff group. Dye leaked to the trachea in six (100%) of the Shiley group compared with none (0%) of the silicone cuff group (P=0.001). This study confirms the effectiveness of this silicone cuff at preventing aspiration and the high incidence of leakage with the conventional high-volume low-pressure tracheostomy tube cuff.

A low-volume, low-pressure tracheal tube cuff reduces pulmonary aspiration*

“…Subglottic to tracheal aspiration was reduced from 100% with a Shiley tracheostomy tube to 0% with the silicone cuff (10). Although achieving statistical significance because of the large effect size, this study was a small pilot study (n ϭ 12), the tube was not designed for this purpose, it was labor intensive to manage, and it was not suitable for general use.…”

“…The LVLP cuff offers advantages over an LVHP cuff as an LVLP cuff allows for accurate tracheal wall pressure control whereas an LVHP cuff does not and is associated with tracheal injury. The LVLP cuff is made of silicone of high compliance, and the principles of its function have been described previously (10,11). The inflation characteristics of the cuff are such that over the adult tracheal diameter range, the pressure within the cuff remains nearly constant (plateaus) at 33-37 mm Hg (45-50 cm H 2 O).…”

“…This is not equal to the intracuff pressure because the cuff does not even touch the tracheal wall (tracheal wall pressure ϭ 0) until Ն33 mm Hg of cuff pressure is achieved. Thereafter, the tracheal wall pressure rises in proportion to the intracuff pressure (10,11). The calculated tracheal wall pressure defaults at 20 mm Hg; this is achieved by raising the intracuff pressure to 50 mm Hg (Fig.…”

“…It retains the advantages of protection against aspiration of the LVHP cuff but also allows the convenient and accurate maintenance of tracheal wall pressure at clinically acceptable levels (10,11). The LVLP tube can be used with a constant pressure inflation device that will maintain cuff inflation continuously.…”

Nosocomial lung infections in adult intensive care units

“…In an attempt to decrease microaspirations into the tracheobronchial tree airway care needs to be improved. Frequent monitoring of endotracheal cuff pressure [20], and use of silicone endotracheal tube cuffs [21] has been shown to reduce the incidence of VAP. In addition, reducing microaspiration by continuous subglottic suction- ing is the only nonpharmacologic preventive strategy for VAP with grade A evidence.…”