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Intensive Care Medicine

, Volume 36, Issue 7, pp 1156–1163 | Cite as

Impact of polyurethane on variations in tracheal cuff pressure in critically ill patients: a prospective observational study

  • Saad Nseir
  • Farid Zerimech
  • Julien De Jonckheere
  • Isabelle Alves
  • Malika Balduyck
  • Alain Durocher
Original

Abstract

Objective

To determine the impact of polyurethane (PU) on variations in cuff pressure (P cuff) in intubated critically ill patients.

Methods

Prospective observational before-after study performed in a ten-bed ICU. Cuff pressure was continuously recorded for 24 h in 76 intubated patients, including 26 with polyvinyl chloride (PVC), 22 with cylindrical polyurethane (CPU), and 28 with tapered polyurethane (TPU)-cuffed tracheal tubes. P cuff was manually adjusted every 8 h by nurses and was maintained around 25 cmH2O. Time spent with cuff underinflation and overinflation was continuously measured. In addition, pepsin, a proxy for microaspiration of gastric contents, was quantitatively measured in tracheal secretions at the end of recording period.

Results

A total of 1,824 h of continuous recording of cuff pressure was analyzed. Patient characteristics were similar in the three groups. No significant difference was found in percentage of time spent with underinflation (mean ± SD, 26 ± 22, 28 ± 12, 30 ± 13% in PVC, CPU, and TPU groups, respectively) and overinflation [median (IQR), 7 (2–14), 6 (3–14), 11% (5–20)] among the three groups. However, a significant difference was found in the coefficient of variation of P cuff (mean ± SD, 82 ± 48, 92 ± 47, 135 ± 67, p = 0.002). While the coefficient of P cuff variation was significantly (p < 0.017) higher in the TPU compared to CPU and PVC groups, no significant difference was found between the CPU and PVC groups. The pepsin level was significantly different among the three groups (408 ± 282, 217 ± 159, 178 ± 126 ng/ml; p < 0.001). In fact, the pepsin level was significantly lower in the CPU and TPU groups compared with the PVC group.

Conclusion

PU does not impact variations in P cuff in critically ill patients.

Keywords

Polyurethane Cuff pressure Microaspiration Intubation Pepsin Complications 

Abbreviations

CPU

Cylindrical polyurethane

ICU

Intensive care unit

PVC

Polyvinyl chloride

PU

Polyurethane

TPU

Tapered polyurethane

VAP

Ventilator-associated pneumonia

Notes

Acknowledgments

We would like to thank Mrs. Véronique Lemaire, Catherine Lelorne, and Nadine Parsy for their skilful assistance in measuring pepsin in tracheal secretions.

Conflict of interest statement

S. Nseir: Covidien, other authors: none

Supplementary material

134_2010_1892_MOESM1_ESM.doc (36 kb)
Supplementary material 1 (DOC 36 kb)

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Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Saad Nseir
    • 1
    • 2
  • Farid Zerimech
    • 3
  • Julien De Jonckheere
    • 4
  • Isabelle Alves
    • 1
  • Malika Balduyck
    • 3
    • 5
  • Alain Durocher
    • 1
    • 2
  1. 1.Intensive Care Unit, Calmette HospitalUniversity Hospital of LilleLille CedexFrance
  2. 2.Medical Assessment Laboratory, EA 2694Lille II UniversityLilleFrance
  3. 3.Biochemistry and Molecular Biology Laboratory, Biochemistry Division, Pathology and Biology CenterUniversity Hospital of LilleLille CedexFrance
  4. 4.Clinical Investigation Center, Innovative Technologies, INSERM CIC-IT 807University Hospital of LilleLoosFrance
  5. 5.Biochemistry and Molecular Biology Laboratory, Faculty of PharmacyLille II UniversityLilleFrance

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