An in-vitro study to evaluate high-volume low-pressure endotracheal tube cuff deflation dynamics
BACKGROUND: High-volume low-pressure (HVLP) endotracheal tube (ETT) cuffs for critically ill patients often deflate during the course of mechanical ventilation. We performed an in-vitro study to comprehensively assess HVLP cuff deflation dynamics and potential preventive measures.
METHODS: We evaluated 24-hour deflation of seven HVLP cuffs of cylindrical or tapered shape, and made of polyvinylchloride or polyurethane. Experiments were performed within a thermostated chamber set at 37 °C. In the first stage of experiments, the cuff pilot balloon valve was not manipulated. The cuff internal pressure was assessed hourly for 24 hours, via a linear position sensor which monitored cuff deflation displacements. Then, we re-evaluated cuff deflation of the worst-performing ETT cuffs with the cuff pilot balloon valve sealed. Finally, we inflated ETT cuffs within an artificial trachea to evaluate deflation dynamics during mechanical ventilation.
RESULTS: Initial tests showed an exponential decrease in cuff internal pressure in five out of seven cuffs. Cuffs of cylindrical shape and made of polyurethane demonstrated the fastest deflation rates (P<0.050 vs. cuffs of conical shape and made of polyvinylchloride). When the cuff pilot balloon valve was not sealed, the internal cuff pressure deflation rate differed significantly among ETTs (P=0.005). Yet, upon sealing the cuff pilot balloon valve and during mechanical ventilation, cuff deflation rates decreased (P<0.050).
CONCLUSIONS: In controlled in-vitro settings, ETT cuffs consistently deflate over time, and the cuff pilot balloon valve plays a central role in this occurrence. Deflation rate decreases when cuffs are inflated within a plastic artificial tracheal model and mechanical ventilation is activated.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:85 |
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| Enthalten in: |
Minerva anestesiologica - 85(2019), 8 vom: 01. Aug., Seite 846-853 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Marti, Joan D [VerfasserIn] |
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| Links: |
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| Themen: |
9002-86-2 |
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| Anmerkungen: |
Date Completed 22.06.2020 Date Revised 22.06.2020 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.23736/S0375-9393.19.13133-1 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM294943870 |
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| 245 | 1 | 3 | |a An in-vitro study to evaluate high-volume low-pressure endotracheal tube cuff deflation dynamics |
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| 520 | |a BACKGROUND: High-volume low-pressure (HVLP) endotracheal tube (ETT) cuffs for critically ill patients often deflate during the course of mechanical ventilation. We performed an in-vitro study to comprehensively assess HVLP cuff deflation dynamics and potential preventive measures | ||
| 520 | |a METHODS: We evaluated 24-hour deflation of seven HVLP cuffs of cylindrical or tapered shape, and made of polyvinylchloride or polyurethane. Experiments were performed within a thermostated chamber set at 37 °C. In the first stage of experiments, the cuff pilot balloon valve was not manipulated. The cuff internal pressure was assessed hourly for 24 hours, via a linear position sensor which monitored cuff deflation displacements. Then, we re-evaluated cuff deflation of the worst-performing ETT cuffs with the cuff pilot balloon valve sealed. Finally, we inflated ETT cuffs within an artificial trachea to evaluate deflation dynamics during mechanical ventilation | ||
| 520 | |a RESULTS: Initial tests showed an exponential decrease in cuff internal pressure in five out of seven cuffs. Cuffs of cylindrical shape and made of polyurethane demonstrated the fastest deflation rates (P<0.050 vs. cuffs of conical shape and made of polyvinylchloride). When the cuff pilot balloon valve was not sealed, the internal cuff pressure deflation rate differed significantly among ETTs (P=0.005). Yet, upon sealing the cuff pilot balloon valve and during mechanical ventilation, cuff deflation rates decreased (P<0.050) | ||
| 520 | |a CONCLUSIONS: In controlled in-vitro settings, ETT cuffs consistently deflate over time, and the cuff pilot balloon valve plays a central role in this occurrence. Deflation rate decreases when cuffs are inflated within a plastic artificial tracheal model and mechanical ventilation is activated | ||
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| 700 | 1 | |a Lazaro, Miguel R |e verfasserin |4 aut | |
| 700 | 1 | |a Aguilera-Xiol, Eli |e verfasserin |4 aut | |
| 700 | 1 | |a Comaru, Talitha |e verfasserin |4 aut | |
| 700 | 1 | |a Battaglini, Denise |e verfasserin |4 aut | |
| 700 | 1 | |a Meli, Andrea |e verfasserin |4 aut | |
| 700 | 1 | |a Ferrer, Miguel |e verfasserin |4 aut | |
| 700 | 1 | |a Navajas, Daniel |e verfasserin |4 aut | |
| 700 | 1 | |a Pelosi, Paolo |e verfasserin |4 aut | |
| 700 | 1 | |a Chiumello, Davide |e verfasserin |4 aut | |
| 700 | 1 | |a Torres, Antoni |e verfasserin |4 aut | |
| 700 | 1 | |a Farre, Ramon |e verfasserin |4 aut | |
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