Endotracheal tubes for critically ill patients: An in vivo analysis of associated tracheal injury , mucociliary clearance, and sealing effi cacy

Gianluigi Li Bassi, Nestor Luque, Joan Daniel Martí, Eli Aguilera Xiol, Marta Di Pasquale, Valeria Giunta, Talitha Comaru, Montserrat Rigol, Silvia Terraneo, Francesca De Rosa, Mariano Rinaudo, Ernesto Crisafulli, Rogelio Cesar Peralta Lepe, Carles Agusti, Carmen Lucena, Miguel Ferrer, Laia Fernández, Antoni Torres

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Improvements in the design of the endotracheal tube (ETT) have been achieved in recent years. We evaluated tracheal injury associated with ETTs with novel high-volume low-pressure (HVLP) cuff s and subglottic secretions aspiration (SSA) and the eff ects on mucociliary clearance (MCC). METHODS: Twenty-nine pigs were intubated with ETTs comprising cylindrical or tapered cuff s and made of polyvinylchloride (PVC) or polyurethane. In specifi c ETTs, SSA was performed every 2 h. Following 76 h of mechanical ventilation, pigs were weaned and extubated. Images of the tracheal wall were recorded before intubation, at extubation, and 24 and 96 h thereaft er through a fl uorescence bronchoscope. We calculated the red-to-green intensity ratio (R/G), an index of tracheal injury, and the green-plus-blue (G 1 B) intensity, an index of normalcy, of the most injured tracheal regions. MCC was assessed through fl uoroscopic tracking of radiopaque markers. Aft er 96 h from extubation, pigs were killed, and a pathologist scored injury. RESULTS: Cylindrical cuff s presented a smaller increase in R/G vs tapered cuff s ( P=.011). Additionally, cuff s made of polyurethane produced a minor increase in R/G ( P=.012) and less G 1 B intensity decline ( P=.022) vs PVC cuff s. Particularly, a cuff made of polyurethane and with a smaller outer diameter outperformed all cuff s. SSA-related histologic injury ranged from cilia loss to subepithelial infl ammation. MCC was 0.9 ± 1.8 and 0.4 ± 0.9 mm/min for polyurethane and PVC cuff s, respectively ( P <.001). CONCLUSIONS: HVLP cuff s and SSA produce tracheal injury, and the recovery is incomplete up to 96 h following extubation. Small, cylindrical-shaped cuff s made of polyurethane cause less injury. MCC decline is reduced with polyurethane cuff s.

Original languageEnglish
Pages (from-to)1327-1335
Number of pages9
JournalChest
Volume147
Issue number5
DOIs
Publication statusPublished - May 1 2015

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

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    Bassi, G. L., Luque, N., Martí, J. D., Xiol, E. A., Pasquale, M. D., Giunta, V., Comaru, T., Rigol, M., Terraneo, S., De Rosa, F., Rinaudo, M., Crisafulli, E., Lepe, R. C. P., Agusti, C., Lucena, C., Ferrer, M., Fernández, L., & Torres, A. (2015). Endotracheal tubes for critically ill patients: An in vivo analysis of associated tracheal injury , mucociliary clearance, and sealing effi cacy. Chest, 147(5), 1327-1335. https://doi.org/10.1378/chest.14-1438