title: Fluid leakage across tracheal tube cuff, effect of different cuff material, shape, and positive expiratory pressure: a bench-top study.
abstract: OBJECTIVE
  Standard polyvinylchloride (PVC) endotracheal tube (ETT) cuffs do not protect from aspiration across the cuff, a leading cause of ventilator-associated pneumonia (VAP). In a long-lasting in vitro study we compared the effect of different cuff materials (PVC, polyurethane, and guayule latex), shapes (cylindrical, conical), and positive end expiratory pressures (PEEP) in reducing fluid leakage across the cuff.
  
  
  METHODS
  We compared fluid leakage across a cylindrical double-layer guayule latex prototype cuff, three cylindrical PVC cuffs (Mallinckrodt Hi-Lo, Mallinckrodt HighContour, Portex Ivory), one conical PVC cuff (Mallinckrodt TaperGuard), and two polyurethane cuffs (Mallinckrodt SealGuard, conical; Microcuff, cylindrical). Ten centimeters of dyed water was poured above the cuffs inflated (pressure 30 cmH(2)O) in a vertical cylinder (diameter 20 mm). A respiratory circuit connected the bottom of the cylinder to a breathing bag inflated at four pressures (PEEP = 0, 5, 10, 15 cmH(2)O). Pictures were taken every 60 s for 24 h to measure leakage as a reduction in the water column above the cuff. Five new ETTs of each type were tested.
  
  
  RESULTS
  The guayule latex cuffs showed no leakage at all the PEEP levels. Both the cylindrical and conical polyurethane cuffs showed limited leakage (2.1 ± 1.8 cm of water) only for PEEP zero. The PVC cuffs showed reduced leakage with increasing PEEP: 8.4 ± 1.5, 7.8 ± 2.2, 2.2 ± 1.0, and 0 cm of water at 0, 5, 10, and 15 cmH(2)O, respectively. Among all the PVC cuffs, the conical shape ensured higher sealing properties.
  
  
  CONCLUSIONS
  The guayule latex cuffs always prevented fluid leakage; the polyurethane and PVC cuffs required incremental levels of PEEP to prevent fluid leakage ever-present at zero PEEP.
authors.affiliation: Department of Experimental Medicine, University of Milan-Bicocca, Via Cadore 48, Monza (MB), Italy. zanella.alb@gmail.com
authors.forename: Alberto
authors.initials: A
authors.lastname: Zanella
authors.forename: Vittorio
authors.initials: V
authors.lastname: Scaravilli
authors.forename: Stefano
authors.initials: S
authors.lastname: Isgrò
authors.forename: Manuela
authors.initials: M
authors.lastname: Milan
authors.forename: Massimo
authors.initials: M
authors.lastname: Cressoni
authors.forename: Nicolò
authors.initials: N
authors.lastname: Patroniti
authors.forename: Roberto
authors.initials: R
authors.lastname: Fumagalli
authors.forename: Antonio
authors.initials: A
authors.lastname: Pesenti
mesh_terms: D004867:Equipment Design; D004868:Equipment Failure; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D010969:Plastics; D011175:Positive-Pressure Respiration
chemical_list: D010969:Plastics