title: Efficiency of a pneumatic device in controlling cuff pressure of polyurethane-cuffed tracheal tubes: a randomized controlled study.
abstract: BACKGROUND
  The primary objective of this study was to determine the efficiency of a pneumatic device in controlling cuff pressure (Pcuff) in patients intubated with polyurethane-cuffed tracheal tubes. Secondary objectives were to determine the impact of continuous control of Pcuff, and cuff shape on microaspiration of gastric contents.
  
  
  METHODS
  Prospective randomized controlled study. All patients requiring intubation and mechanical ventilation ≥48 h were eligible. The first 32 patients were intubated with tapered polyurethane-cuffed, and the 32 following patients were intubated with cylindrical polyurethane-cuffed tracheal tubes. Patients randomly received 24 h of continuous control of Pcuff using a pneumatic device (Nosten®), and 24 h of routine care of Pcuff using a manometer. Target Pcuff was 25 cmH2O. Pcuff was continuously recorded, and pepsin was quantitatively measured in all tracheal aspirates during these periods.
  
  
  RESULTS
  The pneumatic device was efficient in controlling Pcuff (med [IQ] 26 [24, 28] vs 22 [20, 28] cmH2O, during continuous control of Pcuff and routine care, respectively; p = 0.017). In addition, percentage of patients with underinflation (31% vs 68%) or overinflation (53% vs 100%) of tracheal cuff, and percentage of time spent with underinflation (0.9 [0, 17] vs 14% [4, 30]) or overinflation (0 [0, 2] vs 32% [9, 54]) were significantly (p < 0.001) reduced during continuous control of Pcuff compared with routine care.No significant difference was found in microaspiration of gastric content between continuous control of Pcuff compared with routine care, or between patients intubated with tapered compared with cylindrical polyurethane-cuffed tracheal tubes.
  
  
  CONCLUSIONS
  The pneumatic device was efficient in controlling Pcuff in critically ill patients intubated with polyurethane-cuffed tracheal tubes.
  
  
  BACKGROUND
  The Australian New Zealand Clinical Trials Registry (NCT01351259).
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Jaillette
authors.forename: Farid
authors.initials: F
authors.lastname: Zerimech
authors.forename: Julien
authors.initials: J
authors.lastname: De Jonckheere
authors.forename: Demosthenes
authors.initials: D
authors.lastname: Makris
authors.forename: Malika
authors.initials: M
authors.lastname: Balduyck
authors.forename: Alain
authors.initials: A
authors.lastname: Durocher
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.affiliation: Critical Care Center, R, Salengro Hospital, University Hospital of Lille, Rue E, Laine, 59037 Lille cedex, France. s-nseir@chru-lille.fr.
authors.forename: Saad
authors.initials: S
authors.lastname: Nseir