Aspiration beyond endotracheal cuffs

  • Ronald D. Seegobin
  • Gillian L. van Hasselt
Reports of Investigation


Large-volume low-pressure cuffs have been introduced in an endeavour to reduce the incidence of tracheal mucosal damage. These cuffs when inflated to clinical seal develop folds, which together with low clinical seal pressure may not protect against aspiration.

This study compares the incidence of aspiration of dye past a variety of large-volume cuffed tubes and red rubber low-volume cuffs inflated to clinical seal in a group of 30 patients.

The incidence of dye tracking past the large-volume cuffs studies was 100 per cent whereas no aspiration of dye was seen past the red rubber tubes.

Increasing cuff pressure in the large-volume cuffs beyond clinical seal to 50 cm H2O did not obliterate the dye-filled cuff folds, despite wide variation in the thickness of the cuff material.

Key words

Equipment: endotracheal tubes endotracheal tube cuffs Complications: aspiration 


Les ballonnets à basse pression et grand volume ont été introduits afin de diminuer l’incidence des lésions de la muqueuse trachéale. Ces ballonnets quand gonflés afin d’assurer un étanchéité clinique peuvent développer des plicatures qui accompagnées d’une pression d’occlusion basse peuvent ne pas protéger contre l’aspiration.

Cette étude compare l’incidence de l’aspiration de colorant à travers une variété de ballonnets à large volume et les ballonnets à petit volume en caoutchouc rouge gonflés afin d’assurer l’étanchéité clinique dans un groupe de 30 patients.

L’incidence de colorant trouvée au delà des ballonnets à large volume etait de 100 pour cent alors qu’aucune aspiration de colorant n’a été vue au delà des ballonnets à faible volume de tube endotrachéal en caoutchouc rouge.

L’augmentation de la pression dans le ballonnet des tubes endotrachéaux à gros volume jusqu’a 50 cm H2O n’a pas diminué la plicature de ces ballonnets malgré les variations énormes dans l’épaisseur du matériel de ces ballonnets.


  1. 1.
    Carroll RG, McGinnis GE, Grenvik A. Performance characteristics of tracheal cuffs. International Anesthesiology Clinics, 1974; 12: 111–31.PubMedCrossRefGoogle Scholar
  2. 2.
    Pavlin EG, Van Nimwegan D, Hornbein TF. Failure of a high compliance low pressure cuff to prevent aspiration. Anesthesiology, 1975; 42: 216–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Bernhard WN, Cottrell JE, Sivakumaran O, Patel K, Yost L, Turndorf H. Adjustment of intracuff pressure to prevent aspiration. Anesthesiology, 1979; 50: 363–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Seegobin RD, van Hasselt GL. Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs. Br Med J, 1984; 288: 965–8.Google Scholar
  5. 5.
    Pridie RB. Incidence and coincidence of hiatus hernia. Gut, 1966; 7: 188–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Turndorf H, Rodis ID, Clark TS. “Silent” regurgita tion during general anesthesia. Anesth Analg. 1974; 53: 700–3.PubMedGoogle Scholar
  7. 7.
    Spray SB, Zuidema GD, Cameron JL. Aspiration pneumonia: incidence of aspiration with endotracheal tubes. Am J Surg 1976; 131: 701–3.PubMedCrossRefGoogle Scholar
  8. 8.
    Homi J, Notcutt W, Jones JJ, Sparks BR. A method for comparing endotracheal cuffs. Br J Anaesth 1978; 50: 435–45.PubMedCrossRefGoogle Scholar
  9. 9.
    Leigh JM, Maynard JP. Pressure on the tracheal mucosa from cuffed tubes. Br Med J 1979; 1: 1173–4.PubMedCrossRefGoogle Scholar
  10. 10.
    Black AMS, Seegobin RD. Pressures on endotracheal cuffs. Anaesthesia, 1981; 36: 498–511.PubMedCrossRefGoogle Scholar
  11. 11.
    Nordin N. The trachea and cuff induced tracheal injury. An experimental study on causative factors and prevention. Acta Otolaryngology, 1976; 345: 1–71.Google Scholar
  12. 12.
    Metha S. Safe lateral wall pressure to prevent aspiration. Ann R Coll Surg Engl 1984; 66: 426–7.Google Scholar
  13. 13.
    Du Moulin GC, Patterson DG, Hedley-Whyte J, Lisbon A. Aspiration of gastric bacteria in antacid treated patients: a frequent cause of post-operative colonisation of the airway. Lancet 1982; 1: 242–5.PubMedGoogle Scholar
  14. 14.
    Stoutenbeek ChP, Van Saene HKF, Miranda DR, Zandstra DF, Binnendijk B. The prevention of superinfection in multiple trauma patients. J Antimicrob Chemotherapy. 1984; 14: Suppl. B 203–211.Google Scholar

Copyright information

© Canadian Anesthesiologists 1986

Authors and Affiliations

  • Ronald D. Seegobin
    • 1
    • 2
  • Gillian L. van Hasselt
    • 1
  1. 1.The Shakleton Department of AnaesthesiaSouthampton General HospitalSouthampton
  2. 2.Chaleur Regional Hospital, Postal Drawer“S”Bathurst

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