title: Optimal care and design of the tracheal cuff in the critically ill patient.
abstract: Despite the increasing use of non-invasive ventilation and high-flow nasal-oxygen therapy, intubation is still performed in a large proportion of critically ill patients. The aim of this narrative review is to discuss recent data on long-term intubation-related complications, such as microaspiration, and tracheal ischemic lesions. These complications are common in critically ill patients, and are associated with substantial morbidity and mortality. Recent data suggest beneficial effects of tapered cuffed tracheal tubes in reducing aspiration. However, clinical data are needed in critically ill patients to confirm this hypothesis. Polyurethane-cuffed tracheal tubes and continuous control of cuff pressure could be beneficial in preventing microaspiration and ventilator-associated pneumonia (VAP). However, large multicenter studies are needed before recommending their routine use. Cuff pressure should be maintained between 20 and 30 cmH2O to prevent intubation-related complications. Tracheal ischemia could be prevented by manual or continuous control of cuff pressure.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Jaillette
authors.forename: Ignacio
authors.initials: I
authors.lastname: Martin-Loeches
authors.forename: Antonio
authors.initials: A
authors.lastname: Artigas
authors.affiliation: Pôle de Réanimation, Hôpital Salengro, CHRU de Lille, Université Nord de France, Lille, France. s-nseir@chru-lille.fr.
authors.forename: Saad
authors.initials: S
authors.lastname: Nseir