title: Randomized intubation with polyurethane or conical cuffs to prevent pneumonia in ventilated patients.
abstract: BACKGROUND
  The occurrence of ventilator-associated pneumonia (VAP) is linked to the aspiration of contaminated pharyngeal secretions around the endotracheal tube. Tubes with cuffs made of polyurethane rather than polyvinyl chloride or with a conical rather than a cylindrical shape increase tracheal sealing.
  
  
  OBJECTIVE
  To test whether using polyurethane and/or conical cuffs reduces tracheal colonization and VAP in patients with acute respiratory failure.
  
  
  METHODS
  We conducted a multicenter, prospective, open-label, randomized study in four parallel groups in four intensive care units between 2010 and 2012. A cohort of 621 patients with expected ventilation longer than 2 days was included at intubation with a cuff composed of cylindrical polyvinyl chloride (n = 148), cylindrical polyurethane (n = 143), conical polyvinyl chloride (n = 150), or conical polyurethane (n = 162). We used Kaplan-Meier estimates and log-rank tests to compare times to events.
  
  
  RESULTS
  After excluding 17 patients who secondarily refused participation or had met an exclusion criterion, 604 were included in the intention-to-treat analysis. Cumulative tracheal colonization greater than 10(3) cfu/ml at Day 2 was as follows (median [interquartile range]): cylindrical polyvinyl chloride, 0.66 (0.58-0.74); cylindrical polyurethane, 0.61 (0.53-0.70); conical polyvinyl chloride, 0.67 (0.60-0.76); and conical polyurethane, 0.62 (0.55-0.70) (P = 0.55). VAP developed in 77 patients (14.4%), and postextubational stridor developed in 28 patients (6.4%) (P = 0.20 and 0.28 between groups, respectively).
  
  
  CONCLUSIONS
  Among patients requiring mechanical ventilation, polyurethane and/or conically shaped cuffs were not superior to conventional cuffs in preventing tracheal colonization and VAP. Clinical trial registered with clinicaltrials.gov (NCT01114022).
authors.affiliation: 1 Intensive Care Unit and.
authors.forename: François
authors.initials: F
authors.lastname: Philippart
authors.forename: Stéphane
authors.initials: S
authors.lastname: Gaudry
authors.forename: Laurent
authors.initials: L
authors.lastname: Quinquis
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lau
authors.forename: Islem
authors.initials: I
authors.lastname: Ouanes
authors.forename: Samia
authors.initials: S
authors.lastname: Touati
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Nguyen
authors.forename: Catherine
authors.initials: C
authors.lastname: Branger
authors.forename: Frédéric
authors.initials: F
authors.lastname: Faibis
authors.forename: Maha
authors.initials: M
authors.lastname: Mastouri
authors.forename: Xavier
authors.initials: X
authors.lastname: Forceville
authors.forename: Fekri
authors.initials: F
authors.lastname: Abroug
authors.forename: Jean Damien
authors.initials: JD
authors.lastname: Ricard
authors.forename: Sophie
authors.initials: S
authors.lastname: Grabar
authors.forename: Benoît
authors.initials: B
authors.lastname: Misset
mesh_terms: D000368:Aged; D004867:Equipment Design; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000517:prevention & control*; D011140:Polyurethanes; D011143:Polyvinyl Chloride; D011446:Prospective Studies; D014132:Trachea / Q000382:microbiology
chemical_list: D011140:Polyurethanes; D011143:Polyvinyl Chloride
keywords: bacterial colonization; intensive care; tracheal intubation; ventilator-associated pneumonia