Efficiency of a pneumatic device in controlling cuff pressure of polyurethane-cuffed tracheal tubes: a randomized controlled study

BMC Anesthesiology

Emmanuelle Jaillette¹  Farid Zerimech³  Julien De Jonckheere⁴  Demosthenes Makris⁵  Malika Balduyck²  Alain Durocher⁶  Alain Duhamel⁷  Saad Nseir⁶ 

[1] Critical Care Center, R. Salengro Hospital, University Hospital of Lille, Rue E. Laine, 59037 Lille cedex, France

[2] Biochemistry and Molecular Biology Laboratory, Faculty of Pharmacy, Lille II University, 1 place de Verdun, 59045 Lille, France

[3] Biochemistry and Molecular Biology Laboratory, Biochemistry Division, Pathology and Biology Center, University Hospital of Lille, 59037 Lille cedex, France

[4] Clinical Investigation Center - Innovative Technologies, INSERM CIC-IT 807, University Hospital of Lille, 152 rue du Dr Alexandre Yersin, 59120 Loos, France

[5] Intensive Care Unit, University Hospital of Larisa, University of Thessaly, Biopolis Street, 41110 Larisa, Greece

[6] Medical Assessment Laboratory, EA 2694, Nord de France University, 1 place de Verdun, 59045 Lille, France

[7] Epidemiology, Public Health and Quality of Care, Nord-de-France University, Lille, France

关键词: Pneumonia;    Tracheal injury;    Microaspiration;    Tracheal cuff;    Polyurethane;    Intubation;   

Others  :  816643
DOI  :  10.1186/1471-2253-13-50

 received in 2013-03-31, accepted in 2013-12-18,  发布年份 2013

【 摘 要 】

Background

The primary objective of this study was to determine the efficiency of a pneumatic device in controlling cuff pressure (P_cuff) in patients intubated with polyurethane-cuffed tracheal tubes. Secondary objectives were to determine the impact of continuous control of P_cuff, and cuff shape on microaspiration of gastric contents.

Methods

Prospective randomized controlled study. All patients requiring intubation and mechanical ventilation ≥48 h were eligible. The first 32 patients were intubated with tapered polyurethane-cuffed, and the 32 following patients were intubated with cylindrical polyurethane-cuffed tracheal tubes. Patients randomly received 24 h of continuous control of P_cuff using a pneumatic device (Nosten®), and 24 h of routine care of P_cuff using a manometer. Target P_cuff was 25 cmH₂O. P_cuff was continuously recorded, and pepsin was quantitatively measured in all tracheal aspirates during these periods.

Results

The pneumatic device was efficient in controlling P_cuff (med [IQ] 26 [24, 28] vs 22 [20, 28] cmH₂O, during continuous control of P_cuff and routine care, respectively; p = 0.017). In addition, percentage of patients with underinflation (31% vs 68%) or overinflation (53% vs 100%) of tracheal cuff, and percentage of time spent with underinflation (0.9 [0, 17] vs 14% [4, 30]) or overinflation (0 [0, 2] vs 32% [9, 54]) were significantly (p < 0.001) reduced during continuous control of P_cuff compared with routine care.

No significant difference was found in microaspiration of gastric content between continuous control of P_cuff compared with routine care, or between patients intubated with tapered compared with cylindrical polyurethane-cuffed tracheal tubes.

Conclusion

The pneumatic device was efficient in controlling P_cuff in critically ill patients intubated with polyurethane-cuffed tracheal tubes.

Trial registration

The Australian New Zealand Clinical Trials Registry (NCT01351259)

【 授权许可】

   
2013 Jaillette et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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