The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

MICROASPIRATION AND ENDOTRACHEAL TUBE CUFF LEAKAGE: A BENCH STUDY COMPARING POLYURETHANE AND POLYVINYL CHLORIDE ENDOTRACHEAL TUBE CUFF DESIGN

Mark L. Rose, Mike Trevino, Gary Weinstein; Cardiopulmonary, Texas Health Presbyterian Hospital Dallas, Dallas, TX

Background: Reducing the risk of VAP is a major priority among healthcare facilities. Many ideas have been postulated to reduce VAP, including modification of the ETT. Our facility switched from the Mallinckrodt Hi-Lo Evac tube with a barrel-shaped polyvinyl-chloride (PVC) cuff, to the Kimberly-Clark Micro-cuff tube which incorporates an elongated barrel-shaped polyurethane cuff (PUC). We were then presented with the new Mallinckrodt Sealguard tube which uses a novel tapered-down PUC. We then evaluated the cuff for leakage of subglottic fluid in these three branded ETTs. Methodology: A bench-model was achieved by using a mechanical ventilator (1.0L VT, RR = 10), lung simulator and simulated trachea made from a clear plastic tube with a 25mm ID. The ETT was placed in the simulated trachea and its cuff inflated to 30 cwp. The lung simulator was attached to the simulated trachea below the ETT. Five ml’s of blue-dyed water was instilled above each cuff and observed for 30 seconds prior to applying ventilation for a total of 3 minutes. We evaluated the #8.0 Sealguard, #8.0 Hi-Lo Evac, and the #8.0 and 9.0 Micro-cuff. Each ETT was tested 3 times and evaluated for visual leakage below the cuff before and during mechanical ventilation. Results: The Micro-cuff exhibited no visible leakage during each facet of testing. The remaining ETTs all had leakage. Interestingly, the Sealguard had a larger OD and cuff diameter than the Micro-cuff, yet leaked all 5 ml’s of fluid in each of its 3 evaluations. Conclusion: It appears the PVC cuff creates greater folds or channels, which allow subglottic fluid leakage. The thinner PUC material appears to resist this channeling, thereby reducing leakage and potential microaspiration. Additionally, by using a tracheal model sized on the upper end of normal, we feel that cuff shape and overall surface area contact with the tracheal wall are contributing factors for leakage as well. The elongated PUC outperformed the new tapered-down PUC design in our testing model. Sponsored Research - None

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