An endotracheal tube providing "pressurized sealing" prevents fluid leakage in mechanically ventilated critically ill patients: a pilot study

Herbert Spapen, Emiel Suys, Jouke De Regt, Joris Troubleyn, Joop Jonckheer, Elisabeth De Waele

Onderzoeksoutput: Articlepeer review

2 Citaten (Scopus)

Samenvatting

Microaspiration of bacteriologically contaminated oropharyngeal secretions alongside the cuff of an endotracheal tube (ETT) is a key mechanism for development of ventilator-associated pneumonia. We have constructed a prototype double-cuffed ETT equipped with a supplemental port in-between the cuffs through which continuous positive airway pressure (CPAP) is delivered. Pressure in the intercuff space propels secretions upwards and produces 100% tracheal sealing in an in vitro model. We conducted a 24 h study to investigate the sealing effect of this ETT in 12 critically ill mechanically ventilated patients. Methylene blue, instilled through a bronchoscope on top of the proximal cuff, was used as leakage tracer. Fiberoptic visualisation of the trachea was performed 1 h and 24 h thereafter. Leakage was confirmed if blue dye was detected on the tracheal mucosa beyond the tip of the ETT. In no patient, dye passed by the cuffs during the study period. Presence of the ETT did not interfere with ventilator settings, patient mobilization, physiotherapy, and technical acts. Overall, pressures in the intercuff space remained between 10 and 15 cmH2O. Excessive pressure swings were swiftly corrected by the CPAP system. A double-cuffed ETT, offering "pressurized sealing" of the trachea, safely and effectively prevented leakage during 24 h mechanical ventilation.

Originele taal-2English
Pagina's (van-tot)144-148
Aantal pagina's5
TijdschriftJournal of Anesthesia
Volume34
Nummer van het tijdschrift1
Vroegere onlinedatum5 nov 2019
DOI's
StatusPublished - feb 2020

Bibliografische nota

Funding Information:
The authors are indebted to Sumi Company Poland for manufacturing the endotracheal tube and to Michel Timmermans and Michel Vervoort for technical support.

Funding Information:
The study received a research grant from the “Wetenschappelijk Fonds Willy Gepts” of the University Hospital, Vrije Universiteit Brussels.

Publisher Copyright:
© 2019, Japanese Society of Anesthesiologists.

Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.

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