Intensive Care Medicine

, Volume 37, Issue 4, pp 695–700 | Cite as

Mechanical influences on fluid leakage past the tracheal tube cuff in a benchtop model

  • Islem Ouanes
  • Aissam Lyazidi
  • Pierre Eric Danin
  • Nerlep Rana
  • Annalisa Di Bari
  • Fekri Abroug
  • Bruno Louis
  • Laurent Brochard
Experimental

Abstract

Purpose

High-volume low-pressure (HVLP) cuffs on endotracheal tubes do not fully protect the lower airway from leakage of potentially contaminated secretions down the longitudinal folds within the cuff. Here, our purpose was to evaluate potential effects of positive end-expiratory pressure (PEEP), inspiratory effort intensity, and tube characteristics on fluid leakage past the cuff.

Methods

This benchtop study at a research laboratory used a tracheal tube inserted into an artificial Plexiglas trachea connected to a ventilator and lung model. Methylene blue was deposited above the tube cuff to simulate subglottic secretions. Five PEEP levels (0, 5, 10, 15, and 20 cmH2O) were tested with volume-controlled ventilation and three simulated inspiratory effort levels with pressure-support ventilation. Several cuff materials and tube sizes were tested.

Results

The leakage occurrence rate ranged from 91% with zero PEEP to 8% with 15 and 20 cmH2O PEEP and was indirectly proportional to the PEEP level with significant correlation (R2 = 0.39, p < 0.001), an effect not explained by higher peak inspiratory pressure. Low, moderate, and high inspiratory effort intensities were associated with 38%, 46%, and 75% leakage rates, respectively (p = 0.024). Leakage flow was considerably less with polyurethane than with polyvinylchloride tubes (mean 0.5 versus 31.8 ml/h). Leakage increased with larger tube diameters.

Conclusion

This benchtop study shows that PEEP and a polyurethane cuff prevent leakage past the endotracheal tube cuff, whereas greater inspiratory effort and larger tube diameters for given tracheal size induce or worsen leakage.

Keywords

Endotracheal tube Benchtop model PEEP Ventilator-associated pneumonia Pressure-support ventilation 

Supplementary material

134_2011_2145_MOESM1_ESM.doc (294 kb)
Supplementary material 1 (DOC 294 kb)

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Copyright information

© Copyright jointly held by Springer and ESICM 2011

Authors and Affiliations

  • Islem Ouanes
    • 1
    • 2
  • Aissam Lyazidi
    • 2
    • 3
  • Pierre Eric Danin
    • 2
  • Nerlep Rana
    • 2
  • Annalisa Di Bari
    • 2
  • Fekri Abroug
    • 1
  • Bruno Louis
    • 3
    • 4
  • Laurent Brochard
    • 2
    • 3
    • 4
    • 5
  1. 1.Intensive Care UnitFattouma Bourguiba University HospitalMonastirTunisia
  2. 2.Medical Intensive Care UnitAP-HP, Henri Mondor HospitalCreteilFrance
  3. 3.Université PARIS ESTCréteilFrance
  4. 4.INSERM Unit No. 955CréteilFrance
  5. 5.Intensive Care UnitHôpitaux Universitaires de GenèveGeneva 14Switzerland

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