Intensive Care Medicine

, Volume 36, Issue 12, pp 2066–2073

Variables affecting leakage past endotracheal tube cuffs: a bench study

  • Renée Pitts
  • Daniel Fisher
  • Demet Sulemanji
  • Joseph Kratohvil
  • Yandong Jiang
  • Robert Kacmarek
Original

Abstract

Purpose

Leakage of oral secretions past endotracheal tubes (ETT) has been implicated in ventilator associated pneumonia. The aim of this bench study was to compare the ability of current generation ETT cuffs to prevent fluid leakage and to determine the specific mechanical ventilator settings that affect movement of fluid across an inflated ETT cuff.

Methods

Using a 2.3-cm internal diameter (ID) tracheal model and simulated ventilatory support, we evaluated the impact of cuff pressure (20 and 30 cmH2O), positive end-expiratory pressure/continuous positive airway pressure (PEEP/CPAP, 0–15 cmH2O), peak inspiratory pressure (PIP, 15–45 cmH2O), and mode of ventilation (volume control, volume assist/control, pressure control, pressure assist/control, and CPAP) on leakage of fluid past the ETT cuffs of 16 ETTs. The tracheal model was configured in the vertical position with 35 ml of vitaminwater® on top of the inflated ETT cuff and mechanically ventilated. Fluid leakage past the cuff was determined by calculating the volume change in the tracheal model after each 30-min ventilation period. Initially five 8.0-mm-ID ETTs of each manufacturer type were evaluated at baseline ventilator settings. Tubes allowing a consistent leak within two SD of the mean leakage for the five tubes were numbered in consecutive order. A single tube from this group was then randomly selected for detailed evaluation.

Results

Cuff leakage varied among ETT types (p < 0.0001); median leak volume 6.0 ml (0.6–15.1) across all tubes under all conditions. Cuff leakage was inversely related to PEEP level, cuff pressure, and PIP except when PEEP was set at 15 cmH2O (all p < 0.0001). In addition, cuff leak varied among modes (p = 0.035).

Conclusion

Cuff leakage varies greatly among ETT types and is affected by cuff pressure, PEEP, PIP, and mode.

Keywords

Endotracheal tube Aspiration Ventilator associated pneumonia Cuff pressure PEEP Ventilator bundles 

Supplementary material

134_2010_2048_MOESM1_ESM.doc (152 kb)
Supplementary material 1 (DOC 152 kb)

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Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Renée Pitts
    • 1
    • 3
  • Daniel Fisher
    • 2
  • Demet Sulemanji
    • 3
  • Joseph Kratohvil
    • 2
  • Yandong Jiang
    • 3
  • Robert Kacmarek
    • 3
  1. 1.Department of Respiratory CareMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Respiratory Care ServicesMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  3. 3.Department of Anesthesia, Critical Care and Pain MedicineMassachusetts General Hospital and Harvard Medical SchoolBostonUSA

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