Document Detail

Mechanical influences on fluid leakage past the tracheal tube cuff in a benchtop model.
MedLine Citation:
PMID:  21318434     Owner:  NLM     Status:  Publisher    
PURPOSE: High-volume low-pressure (HVLP) cuffs on endotracheal tubes do not fully protect the lower airway from leakage of potentially contaminated secretions down the longitudinal folds within the cuff. Here, our purpose was to evaluate potential effects of positive end-expiratory pressure (PEEP), inspiratory effort intensity, and tube characteristics on fluid leakage past the cuff. METHODS: This benchtop study at a research laboratory used a tracheal tube inserted into an artificial Plexiglas trachea connected to a ventilator and lung model. Methylene blue was deposited above the tube cuff to simulate subglottic secretions. Five PEEP levels (0, 5, 10, 15, and 20 cmH(2)O) were tested with volume-controlled ventilation and three simulated inspiratory effort levels with pressure-support ventilation. Several cuff materials and tube sizes were tested. RESULTS: The leakage occurrence rate ranged from 91% with zero PEEP to 8% with 15 and 20 cmH(2)O PEEP and was indirectly proportional to the PEEP level with significant correlation (R (2) = 0.39, p < 0.001), an effect not explained by higher peak inspiratory pressure. Low, moderate, and high inspiratory effort intensities were associated with 38%, 46%, and 75% leakage rates, respectively (p = 0.024). Leakage flow was considerably less with polyurethane than with polyvinylchloride tubes (mean 0.5 versus 31.8 ml/h). Leakage increased with larger tube diameters. CONCLUSION: This benchtop study shows that PEEP and a polyurethane cuff prevent leakage past the endotracheal tube cuff, whereas greater inspiratory effort and larger tube diameters for given tracheal size induce or worsen leakage.
Islem Ouanes; Aissam Lyazidi; Pierre Eric Danin; Nerlep Rana; Annalisa Di Bari; Fekri Abroug; Bruno Louis; Laurent Brochard
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-12
Journal Detail:
Title:  Intensive care medicine     Volume:  -     ISSN:  1432-1238     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Intensive Care Unit, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
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