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Bulpa P. 1, Evrard P. 1, Bouhon S. 1, Schryvers F. 2, Jamart J. 3, Michaux I. 1, Dive A. 1, Vander Borght T. 2, Krug B. 2
1 Intensive Care Unit, CHU Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium;
2 Nuclear Medicine Unit, CHU Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium;
3 Scientific Support Unit, CHU Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium
Background: Mechanically ventilated patients are prone to develop ventilator associated pneumonia due to microaspirations of subglottic secretions around the endotracheal tube cuff (usually constructed of polyvinyl material). A novel polyurethane cuff has been designed to minimize these leakages. The aim of the study was to compare the tracheal sealing capacities between the two tubes.
Methods: Twenty-nine consecutive patients from whom tracheal intubation was necessary as part of their care were randomized to receive either a polyvinyl HI-LO Evac® or a polyurethane SEALGUARD Evac® endotracheal tube. Patients requiring emergency intubation, with unstable hemodynamics or history of tracheal/laryngeal disease were excluded. For the entire study, cuff pressure was set at 30 cmH2O, and ventilator parameters were adjusted for a plateau pressure ≤30 cmH2O; Patients were fasting, placed in a strict 45° position during 12 hours and sedated if needed. After injection of 74 MBq 99mTc-DTPA diluted in 5 mL 0.9% NaCl just above the cuff, tracheal radioactivity was assessed sequentially (hourly from T0 to T6, then T8 and T12 hours) using a scintillation camera.
Results: Sixteen polyurethane and 13 polyvinyl tubes were compared. Leakages were observed in 11/29 patients (38%) (5/16 polyurethane and 6/13 polyvinyl tubes [P=NS]). Leakages occurred more often in female (7/8) than in male patients (4/21) (P<0.001). Microaspirations were decreased with larger tubes (size 9 vs. ≤8.5: 24% vs. 75%; P=0.01), whatever the cuff membrane.
Conclusion: These preliminary results suggest that both tubes are poorly effective in preventing microaspirations.