Gel lubrication of the tracheal tube cuff reduces pulmonary aspiration.
BACKGROUND
Leakage of fluid occurs along the longitudinal folds within the wall of an inflated high-volume, low-pressure cuff. Theoretically, lubrication of the cuff with a water-soluble gel might prevent aspiration by plugging the channels in the cuff wall. Pulmonary aspiration during anesthesia has been linked with postoperative pneumonia and during critical illness causes ventilator-associated pneumonia.


METHODS
Lubricated cuffs were compared with nonlubricated cuffs for leakage of dye placed in the subglottic space to the tracheobronchial tree in a benchtop model (n = 5) and in a prospective double-blinded randomized controlled trial of anesthetized patients (n = 36). The duration of the efficacy of the lubricant was determined in a prospective open observational study of critically ill patients with tracheostomies (n = 9). Dye was detected clinically by dye coloration of secretions during tracheal suctioning.


RESULTS
In the benchtop model the incidence of leakage was 0% in the lubrication group and 100% in the nonlubrication group (P < 0.01). Dye leakage in anesthetized patients was 11% in the lubrication group and 83% in the nonlubrication group (P < 0.0001). In the critically ill patients with lubricated cuffed tracheostomy tubes, leakage first occurred after a median period of 48 h (range, 24-120 h).


CONCLUSIONS
Cuff lubrication with a water-soluble gel reduces pulmonary aspiration in anesthetized patients. In the critically ill patient with a tracheostomy the protective effect is lost after 24-120 h.
Blunt
M C
MC
Department of Anaesthesia, Queen Elizabeth Hospital, King Lynn, United Kingdom. markblunt@eaicg.com
Young
P J
PJ
Patil
A
A
Haddock
A
A
D000328:Adult; D000818:Animals; D016638:Critical Illness; D004311:Double-Blind Method; D005260:Female; D005782:Gels; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008153:Lubrication; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D011015:Pneumonia, Aspiration / Q000517:prevention & control*; D011446:Prospective Studies; D013552:Swine; D014139:Tracheostomy
D005782:Gels