Abstract
Purpose: Standard polyvinylchloride (PVC) endotracheal tube (ETT) cuffs do not protect from aspiration across the cuff, a leading cause of ventilator-associated pneumonia (VAP). In a long-lasting in vitro study we compared the effect of different cuff materials (PVC, polyurethane, and guayule latex), shapes (cylindrical, conical), and positive end expiratory pressures (PEEP) in reducing fluid leakage across the cuff. Methods: We compared fluid leakage across a cylindrical double-layer guayule latex prototype cuff, three cylindrical PVC cuffs (Mallinckrodt Hi-Lo, Mallinckrodt HighContour, Portex Ivory), one conical PVC cuff (Mallinckrodt TaperGuard), and two polyurethane cuffs (Mallinckrodt SealGuard, conical; Microcuff, cylindrical). Ten centimeters of dyed water was poured above the cuffs inflated (pressure 30 cmH 2O) in a vertical cylinder (diameter 20 mm). A respiratory circuit connected the bottom of the cylinder to a breathing bag inflated at four pressures (PEEP = 0, 5, 10, 15 cmH2O). Pictures were taken every 60 s for 24 h to measure leakage as a reduction in the water column above the cuff. Five new ETTs of each type were tested. Results: The guayule latex cuffs showed no leakage at all the PEEP levels. Both the cylindrical and conical polyurethane cuffs showed limited leakage (2.1 ± 1.8 cm of water) only for PEEP zero. The PVC cuffs showed reduced leakage with increasing PEEP: 8.4 ± 1.5, 7.8 ± 2.2, 2.2 ± 1.0, and 0 cm of water at 0, 5, 10, and 15 cmH2O, respectively. Among all the PVC cuffs, the conical shape ensured higher sealing properties. Conclusions: The guayule latex cuffs always prevented fluid leakage; the polyurethane and PVC cuffs required incremental levels of PEEP to prevent fluid leakage ever-present at zero PEEP.
| Original language | English |
|---|---|
| Pages (from-to) | 343-347 |
| Number of pages | 5 |
| Journal | Intensive Care Medicine |
| Volume | 37 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - Feb 2011 |
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Keywords
- Aspiration
- Endotracheal tube cuff
- Fluid leakage
- Positive end expiratory pressure
- Ventilator-associated pneumonia
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine
Cite this
Fluid leakage across tracheal tube cuff, effect of different cuff material, shape, and positive expiratory pressure : A bench-top study. / Zanella, Alberto; Scaravilli, Vittorio; Isgrò, Stefano; Milan, Manuela; Cressoni, Massimo; Patroniti, Nicolò; Fumagalli, Roberto; Pesenti, Antonio.
In: Intensive Care Medicine, Vol. 37, No. 2, 02.2011, p. 343-347.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Fluid leakage across tracheal tube cuff, effect of different cuff material, shape, and positive expiratory pressure
T2 - A bench-top study
AU - Zanella, Alberto
AU - Scaravilli, Vittorio
AU - Isgrò, Stefano
AU - Milan, Manuela
AU - Cressoni, Massimo
AU - Patroniti, Nicolò
AU - Fumagalli, Roberto
AU - Pesenti, Antonio
PY - 2011/2
Y1 - 2011/2
N2 - Purpose: Standard polyvinylchloride (PVC) endotracheal tube (ETT) cuffs do not protect from aspiration across the cuff, a leading cause of ventilator-associated pneumonia (VAP). In a long-lasting in vitro study we compared the effect of different cuff materials (PVC, polyurethane, and guayule latex), shapes (cylindrical, conical), and positive end expiratory pressures (PEEP) in reducing fluid leakage across the cuff. Methods: We compared fluid leakage across a cylindrical double-layer guayule latex prototype cuff, three cylindrical PVC cuffs (Mallinckrodt Hi-Lo, Mallinckrodt HighContour, Portex Ivory), one conical PVC cuff (Mallinckrodt TaperGuard), and two polyurethane cuffs (Mallinckrodt SealGuard, conical; Microcuff, cylindrical). Ten centimeters of dyed water was poured above the cuffs inflated (pressure 30 cmH 2O) in a vertical cylinder (diameter 20 mm). A respiratory circuit connected the bottom of the cylinder to a breathing bag inflated at four pressures (PEEP = 0, 5, 10, 15 cmH2O). Pictures were taken every 60 s for 24 h to measure leakage as a reduction in the water column above the cuff. Five new ETTs of each type were tested. Results: The guayule latex cuffs showed no leakage at all the PEEP levels. Both the cylindrical and conical polyurethane cuffs showed limited leakage (2.1 ± 1.8 cm of water) only for PEEP zero. The PVC cuffs showed reduced leakage with increasing PEEP: 8.4 ± 1.5, 7.8 ± 2.2, 2.2 ± 1.0, and 0 cm of water at 0, 5, 10, and 15 cmH2O, respectively. Among all the PVC cuffs, the conical shape ensured higher sealing properties. Conclusions: The guayule latex cuffs always prevented fluid leakage; the polyurethane and PVC cuffs required incremental levels of PEEP to prevent fluid leakage ever-present at zero PEEP.
AB - Purpose: Standard polyvinylchloride (PVC) endotracheal tube (ETT) cuffs do not protect from aspiration across the cuff, a leading cause of ventilator-associated pneumonia (VAP). In a long-lasting in vitro study we compared the effect of different cuff materials (PVC, polyurethane, and guayule latex), shapes (cylindrical, conical), and positive end expiratory pressures (PEEP) in reducing fluid leakage across the cuff. Methods: We compared fluid leakage across a cylindrical double-layer guayule latex prototype cuff, three cylindrical PVC cuffs (Mallinckrodt Hi-Lo, Mallinckrodt HighContour, Portex Ivory), one conical PVC cuff (Mallinckrodt TaperGuard), and two polyurethane cuffs (Mallinckrodt SealGuard, conical; Microcuff, cylindrical). Ten centimeters of dyed water was poured above the cuffs inflated (pressure 30 cmH 2O) in a vertical cylinder (diameter 20 mm). A respiratory circuit connected the bottom of the cylinder to a breathing bag inflated at four pressures (PEEP = 0, 5, 10, 15 cmH2O). Pictures were taken every 60 s for 24 h to measure leakage as a reduction in the water column above the cuff. Five new ETTs of each type were tested. Results: The guayule latex cuffs showed no leakage at all the PEEP levels. Both the cylindrical and conical polyurethane cuffs showed limited leakage (2.1 ± 1.8 cm of water) only for PEEP zero. The PVC cuffs showed reduced leakage with increasing PEEP: 8.4 ± 1.5, 7.8 ± 2.2, 2.2 ± 1.0, and 0 cm of water at 0, 5, 10, and 15 cmH2O, respectively. Among all the PVC cuffs, the conical shape ensured higher sealing properties. Conclusions: The guayule latex cuffs always prevented fluid leakage; the polyurethane and PVC cuffs required incremental levels of PEEP to prevent fluid leakage ever-present at zero PEEP.
KW - Aspiration
KW - Endotracheal tube cuff
KW - Fluid leakage
KW - Positive end expiratory pressure
KW - Ventilator-associated pneumonia
UR - http://www.scopus.com/inward/record.url?scp=79953826042&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79953826042&partnerID=8YFLogxK
U2 - 10.1007/s00134-010-2106-z
DO - 10.1007/s00134-010-2106-z
M3 - Article
C2 - 21152894
AN - SCOPUS:79953826042
VL - 37
SP - 343
EP - 347
JO - Intensive Care Medicine
JF - Intensive Care Medicine
SN - 0342-4642
IS - 2
ER -