Efficiency of a pneumatic device in controlling cuff pressure of polyurethane-cuffed tracheal tubes: a randomized controlled study
- Equal contributors
1 Critical Care Center, R. Salengro Hospital, University Hospital of Lille, Rue E. Laine, 59037 Lille cedex, France
2 Biochemistry and Molecular Biology Laboratory, Biochemistry Division, Pathology and Biology Center, University Hospital of Lille, 59037 Lille cedex, France
3 Clinical Investigation Center - Innovative Technologies, INSERM CIC-IT 807, University Hospital of Lille, 152 rue du Dr Alexandre Yersin, 59120 Loos, France
4 Intensive Care Unit, University Hospital of Larisa, University of Thessaly, Biopolis Street, 41110 Larisa, Greece
5 Biochemistry and Molecular Biology Laboratory, Faculty of Pharmacy, Lille II University, 1 place de Verdun, 59045 Lille, France
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
BMC Anesthesiology 2013, 13:50 doi:10.1186/1471-2253-13-50Published: 26 December 2013
The primary objective of this study was to determine the efficiency of a pneumatic device in controlling cuff pressure (Pcuff) in patients intubated with polyurethane-cuffed tracheal tubes. Secondary objectives were to determine the impact of continuous control of Pcuff, and cuff shape on microaspiration of gastric contents.
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 Pcuff using a pneumatic device (Nosten®), and 24 h of routine care of Pcuff using a manometer. Target Pcuff was 25 cmH2O. Pcuff was continuously recorded, and pepsin was quantitatively measured in all tracheal aspirates during these periods.
The pneumatic device was efficient in controlling Pcuff (med [IQ] 26 [24, 28] vs 22 [20, 28] cmH2O, during continuous control of Pcuff 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 Pcuff compared with routine care.
No significant difference was found in microaspiration of gastric content between continuous control of Pcuff compared with routine care, or between patients intubated with tapered compared with cylindrical polyurethane-cuffed tracheal tubes.
The pneumatic device was efficient in controlling Pcuff in critically ill patients intubated with polyurethane-cuffed tracheal tubes.
The Australian New Zealand Clinical Trials Registry (NCT01351259)