The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

EVALUATION OF ENDOTRACHEAL TUBE CUFF LEAKAGE IN A HUMAN CADAVER MODEL.

Tim Op’t Holt, Zachary Trost; Cardiorespiratory Care, Univ of South Alabama, Mobile, AL

Background: Aspiration of oral secretions is documented as a cause of ventilator associated pneumonia (VAP). A variety of cuff shapes and styles have been introduced to decrease leakage of oral secretions beyond the cuff. This study compares cuff leakage using the Microcuff endotracheal tube with other brands, using a cadaver trachea instead of a PVC tracheal model, previously evaluated. We hypothesized that the leakage beyond the cuff of the Microcuff endotracheal tube would be less than that of other endotracheal tubes. Methods: Kimberly-Clark polyurethane Microcuff, Mallinckrodt Hilo, Mallinckrodt LoPro, and Sheridan CF Tracheal endotracheal tubes were inserted into a vertically-oriented, preserved cadaver trachea (I.D. 20mm) and cuffs were inflated to 15, 20, 25, and 30 cmH2O. Colored water (5 mL) was added to the top of each cuff and leakage was measured by a graduated cylinder at 1, 5, and 30 minutes. Trials were repeated once more. ANOVA was used to analyze the differences in leak volume among the tubes, with a=.05. In a second experiment, the tubes were coated with radiographic contrast, the trachea was intubated, and the cuffs were pressurized to 25 cm H2O. CT scans were done on the intubated trachea to determine the formation of microchannels within each cuff. Results: Both the Microcuff and HiLo allowed very little leakage while the LoPro and CF tracheal tubes showed significantly more leakage (p<0.05) among all pressures and times. CT scans revealed that the Microcuff was the only tube without microchannel formation. Conclusion: Both the Microcuff and HiLo cuffs had negligible leakage at cuff pressure ranges lower than the recommended range of 20-30 cmH2O. These tubes may be better than others in helping to prevent aspiration of oral secretions, which supports out hypothesis. The polyurethane material in the Microcuff may be a factor in eliminating microchannel formation. Prevention of aspiration is a major factor in preventing VAP. Sponsored Research - Endotracheal tubes were provided by Kimberly Clark and local hospitals.