title: Interrupting gel layer between Double cuffs prevents fluid leakage past tracheal tube cuffs.
abstract: BACKGROUND
  Current tracheal tubes (TTs) cannot guarantee a perfect seal against pulmonary aspiration of upper airway secretions. The purpose of this study was to investigate whether a gel layer between the tracheal tube with double cuffs (Double cuffs) prevents fluid leakage past TT cuffs.
  
  
  METHODS
  In vitro fluid leakage tests were performed using the Double cuff with or without a gel layer between the two cuffs and four commercially available TTs (Euromedical Standard TT, Mallinckrodt Hi-Lo™, Microcuff, and Mallinckrodt TaperGuard™) when placed in artificial tracheas with three-different internal diameters (ID; 16, 20, and 22 mm). Blue-dyed water (5 ml) was placed above the cuff, and the extent of fluid leakage was observed for 48 h. Each test was repeated five times with new tubes at six different intracuff pressures (15, 20, 25, 30, 40, and 50 cm H2O).
  
  
  RESULTS
  In all of the conventional TTs and the Double cuff without a gel layer, fluid leakage was observed even at clinically acceptable intracuff pressures (25-30 cm H2O). However, in the Double cuff with a gel layer, no fluid leakage was observed for 48 h at all intracuff pressures in three-different sized artificial tracheas. At an intracuff pressure of 20 cm H2O in a 20 mm ID trachea, the average volume of injected gel was 2.0 ml. After removal of the TT, the mean volume of the remaining gel in the trachea was 0.10 ml.
  
  
  CONCLUSIONS
  A prototype TT with gel-layered Double cuffs completely blocked fluid leakage past the cuffs for 48 h in a bench-top model. Clinical studies are required to determine whether this TT reduces the risk of ventilator-associated pneumonia.
authors.affiliation: Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.
authors.forename: J Y
authors.initials: JY
authors.lastname: Hwang
authors.forename: S H
authors.initials: SH
authors.lastname: Han
authors.forename: S H
authors.initials: SH
authors.lastname: Park
authors.forename: S J
authors.initials: SJ
authors.lastname: Park
authors.forename: S
authors.initials: S
authors.lastname: Park
authors.forename: S H
authors.initials: SH
authors.lastname: Oh
authors.forename: J H
authors.initials: JH
authors.lastname: Kim
mesh_terms: D004867:Equipment Design; D019544:Equipment Failure Analysis / Q000379:methods*; D005782:Gels; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008953:Models, Anatomic
chemical_list: D005782:Gels
keywords: cuffs tracheal, complications; equipment; respiratory aspiration