title: Assessment of intraoperative microaspiration: does a modified cuff shape improve sealing?
abstract: BACKGROUND
  Intra-operative aspiration of oropharyngeal secretions is associated with post-operative pneumonia. The use of endotracheal tubes (ETTs) with a modified cuff shape could be one preventive action. In this clinical, prospective, randomised controlled trial, we hypothesised that altering the cuff shape to a tapered shape could reduce the aspiration incidence. The primary outcome was aspiration of dye solution into the trachea.
  
  
  METHODS
  Patients scheduled for lumbar surgery were intubated with either an ETT with a barrel-shaped polyvinylchloride cuff (control group, n = 30) or tapered-shaped polyvinylchloride cuff (intervention group, n = 30). Subsequently, instillation with methylthioninium chloride was performed. At 10, 30, 60, 90, and 120 min after intubation, bronchoscopy was performed assessing the degree of dye descent along the cuff and digitally stored. Single blind review of the videoclips provided data on incidence of dye aspiration and depth of penetration along the cuff.
  
  
  RESULTS
  The traditional cuff showed descent of dye into the trachea in 20% of the patients. Although a tapered-shaped polyvinylchloride cuff leaked up to the second third of the cuff, no dye leakage into the trachea was observed. The use of a tapered-shaped cuff had a protective role against aspiration (T30: OR 3.0, CI 1.57-5.75; P = 0.001).
  
  
  CONCLUSIONS
  Short-term use of tapered-shaped polyvinylchloride cuffs in surgical patients results in more effective sealing of the tracheal lumen in comparison with a traditional barrel-shaped polyvinylchloride cuffs. Further evaluation is needed to determine whether a reduction in post-operative pneumonia can be demonstrated when these cuffs are used.
authors.affiliation: Department of Anaesthesiology and Perioperative Medicine, Pneumology and Neurosurgery, University Hospital, Brussels, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: D'Haese
authors.forename: T
authors.initials: T
authors.lastname: De Keukeleire
authors.forename: I
authors.initials: I
authors.lastname: Remory
authors.forename: K
authors.initials: K
authors.lastname: Van Rompaey
authors.forename: V
authors.initials: V
authors.lastname: Umbrain
authors.forename: J
authors.initials: J
authors.lastname: Poelaert
mesh_terms: D000328:Adult; D000368:Aged; D001999:Bronchoscopy; D004396:Coloring Agents; D004867:Equipment Design; D005260:Female; D006801:Humans; D007322:Instillation, Drug; D007403:Intervertebral Disc / Q000601:surgery; D007431:Intraoperative Complications / Q000517:prevention & control*; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008751:Methylene Blue; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D063466:Respiratory Aspiration of Gastric Contents / Q000517:prevention & control*; D016037:Single-Blind Method; D014132:Trachea
chemical_list: D004396:Coloring Agents; D008751:Methylene Blue