Control of tracheal cuff pressure: a pilot study using a pneumatic device.
OBJECTIVE
To evaluate the efficacy of a simple mechanical device to maintain constant endotracheal cuff pressure (Pcuff) during mechanical ventilation (large encased inflatable cuff connected to the endotracheal cuff and receiving constant pressure from a heavy mass attached to an articulated arm).


METHODS
Single-center, prospective, randomized, crossover, pilot study in a medical intensive care unit.


METHODS
Nine consecutive mechanically ventilated patients (age 62+/-20 years, SAPS II score 39+/-15).


METHODS
Control day: Pcuff monitored and adjusted with a manometer (Hi-Lo, Tyco Healthcare) according to current recommendations (twice a day and after each intervention on the tracheal tube); initial target Pcuff 22-28 cmH20. Prototype day: test device connected to the endotracheal cuff; same initial target. Continuous Pcuff recording during both days. Control and prototype days in random order.


RESULTS
Pcuff values over 50 cmH20 were recorded in six patients during the control day (178+/-159min), never during the prototype day. During the control day, Pcuff was between 30 and 50 cmH20 for 29+/-25% of the time, vs 0.3+/-0.3% during the prototype day (p<0.01). Pcuff was between 15 and 30 cmH20 for 56+/-36% of the time during the control day, vs 95+/-14% during the prototype day p<0.01). During the control day, Pcuff was below 15 cmH20 for 15+/-17% of the time, vs 4.7+/-15% during the prototype day (p<0.05).


CONCLUSIONS
The tested device successfully controlled Pcuff with minimal human resource consumption. Prospective studies are required to assess its clinical impact.
Duguet
Alexandre
A
Unité de Réanimation, Service de Pneumologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, Bd de l'Hôpital, 75651, Paris Cedex 13, France. alexandre.duguet@psl.ap-hop-paris.fr
D'Amico
Leda
L
Biondi
Giuseppina
G
Prodanovic
Hélène
H
Gonzalez-Bermejo
Jésus
J
Similowski
Thomas
T
D018592:Cross-Over Studies; D004867:Equipment Design; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011312:Pressure; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000295:instrumentation*