title: Evaluation of an automated endotracheal tube cuff controller during simulated mechanical ventilation.
abstract: BACKGROUND
  Maintaining endotracheal tube cuff pressure within a narrow range is an important factor in patient care. The goal of this study was to evaluate the IntelliCuff against the manual technique for maintaining cuff pressure during simulated mechanical ventilation with and without movement.
  
  
  METHODS
  The IntelliCuff was compared to the manual technique of a manometer and syringe. Two independent studies were performed during mechanical ventilation: part 1, a 2-h trial incorporating continuous mannikin head movement; and part 2, an 8-h trial using a stationary trachea model. We set cuff pressure to 25 cm H2O, PEEP to 10 cm H2O, and peak inspiratory pressures to 20, 30, and 40 cm H2O. Clinical importance was defined as both statistically significant (P<.05) and clinically significant (pressure change [Δ]>10%).
  
  
  RESULTS
  In part 1, the change in cuff pressure from before to after ventilation was clinically important for the manual technique (P<.001, Δ=-39.6%) but not for the IntelliCuff (P=.02, Δ=3.5%). In part 2, the change in cuff pressure from before to after ventilation was clinically important for the manual technique (P=.004, Δ=-14.39%) but not for the IntelliCuff (P=.20, Δ=5.65%).
  
  
  CONCLUSIONS
  There was a clinically important drop in manually set cuff pressure during simulated mechanical ventilation in a stationary model and an even larger drop with movement, but this was significantly reduced by the IntelliCuff in both scenarios. Additionally, we observed that cuff pressure varied directly with inspiratory airway pressure for both techniques, leading to elevated average cuff pressures.
authors.affiliation: Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Chenelle
authors.affiliation: Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts. Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Jun
authors.initials: J
authors.lastname: Oto
authors.affiliation: Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts. Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Demet
authors.initials: D
authors.lastname: Sulemanji
authors.affiliation: Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Fisher
authors.affiliation: Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts. Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. rkacmarek@mgh.harvard.edu.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kacmarek
mesh_terms: D004867:Equipment Design; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008348:Manikins; D008365:Manometry; D009038:Motion; D011312:Pressure; D012121:Respiration, Artificial / Q000295:instrumentation*
keywords: ETT cuff; IntelliCuff; cuff pressure; cuff pressure controller; endotracheal tube; mechanical ventilation