Monsel Antoine, Le Corre Marine, Deransy Romain, Brisson Hélène, Arbelot Charlotte, Lu Qin, Golmard Jean-Louis, Langeron Olivier, Rouby Jean-Jacques
Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, UPMC Université, Paris, France.
Department of Biostatistic, ER4/EA3974, UPMC Université, Paris, France.
Crit Care Med. 2017 Dec;45(12):e1262-e1269. doi: 10.1097/CCM.0000000000002764.
Microaspiration of subglottic secretions plays a pivotal role in ventilator-associated pneumonia. Impact of endotracheal tube cuff material and shape on tracheal sealing performance remains debated. The primary objective was to compare the tracheal sealing performance of polyvinyl chloride tapered, cylindrical and spherical cuffs. Secondary objectives were to determine the impact of continuous cuff pressure control on sealing performance and pressure variability.
Prospective randomized ex vivo animal study.
French research laboratory.
Seventy-two ex vivo pig tracheal two-lung blocks.
Blocks were randomly intubated with cylindrical (n = 26), tapered (n = 24), or spherical (n = 22) polyvinyl chloride endotracheal tube cuffs. Two milliliter of methylene blue were instilled above the cuff to quantify microaspirations, and lungs were ventilated for 2 hours. Continuous cuff pressure control was implemented in 33 blocks.
Cuff pressures were continuously recorded, and after 2 hours, a microaspiration score was calculated. Tapered cuffs improved cuff sealing performance compared with spherical cuffs with or without continuous cuff pressure control. Compared with spherical cuffs, tapered cuffs reduced the microaspiration score without and with continuous pressure control by 65% and 72%, respectively. Continuous cuff pressure control did not impact sealing performance. Tapered cuffs generated higher cuff pressures and increased the time spent with overinflation compared with spherical cuffs (median [interquartile range], 77.9% [0-99.8] vs. 0% [0-0.5]; p = 0.03). Continuous cuff pressure control reduced the variability of tapered and spherical cuffs likewise the time spent with overinflation of tapered and cylindrical cuffs.
Polyvinyl chloride tapered cuffs sealing enhanced performance at the cost of an increase in cuff pressure and in time spent with overinflation. Continuous cuff pressure control reduced the variability and normalized cuff pressures without impacting sealing performance.
声门下分泌物的微量误吸在呼吸机相关性肺炎中起关键作用。气管导管套囊材料和形状对气管密封性能的影响仍存在争议。主要目的是比较聚氯乙烯锥形、圆柱形和球形套囊的气管密封性能。次要目的是确定持续套囊压力控制对密封性能和压力变异性的影响。
前瞻性随机离体动物研究。
法国研究实验室。
72个离体猪气管双肺块。
将圆柱形（n = 26）、锥形（n = 24）或球形（n = 22）聚氯乙烯气管导管套囊随机插入肺块。在套囊上方注入2毫升亚甲蓝以量化微量误吸，并对肺进行2小时通气。33个肺块实施持续套囊压力控制。
持续记录套囊压力，2小时后计算微量误吸评分。与球形套囊相比，无论有无持续套囊压力控制，锥形套囊均改善了套囊密封性能。与球形套囊相比，在无持续压力控制和有持续压力控制的情况下，锥形套囊分别将微量误吸评分降低了65%和72%。持续套囊压力控制不影响密封性能。与球形套囊相比，锥形套囊产生更高的套囊压力，并增加了过度充气的时间（中位数[四分位间距]，77.9%[0 - 99.8]对0%[0 - 0.5]；p = 0.03）。持续套囊压力控制同样降低了锥形和球形套囊的变异性以及锥形和圆柱形套囊过度充气的时间。
聚氯乙烯锥形套囊以增加套囊压力和过度充气时间为代价提高了密封性能。持续套囊压力控制降低了变异性并使套囊压力正常化，而不影响密封性能。
