title: Endotracheal Tube Seal and Suction Performance in a Novel Biorealistic Tracheal Model.
abstract: BACKGROUND
  Endotracheal tube (ETT) cuffs create a seal to protect against secretion entry to the lungs. Cuff inflation currently is recommended at 20-30 cm H2O pressure. ETT designs have variable seal performance in bench studies using rigid tracheal models lacking the dynamic characteristics of the human trachea. We compared ETT designs within a new, biorealistic tracheal model to assess cuff and suction performance in the setting of a compliant trachea.
  
  
  METHODS
  Three ETT designs (Mallinckrodt Hi-Lo, KimVent Microcuff, and Sheridan/HVT) were tested for performance by simulant leakage below the cuff and air leakage (measured as return tidal volume ≥ 80% delivered) over a range of cuff (5-25 cm H2O) and end-expiratory pressure (PEEP 0-15 cm H2O). Subglottic suction channel performance was tested in 2 ETTs (TaperGuard Evac [Covidien] and ISIS HVT [Teleflex]) as time to evacuate the simulant.
  
  
  RESULTS
  All ETT cuffs provided effective seals at an inflation pressure of 12 cm H2O when PEEP was ≤ 5 cm H2O. The Microcuff ETT sealed at the lowest pressure of 6 cm H2O, whereas the Sheridan/HVT cuff sealed at 12 cm H2O (P = .01). With a PEEP of 15 cm H2O, a reciprocal increase in air leak occurred, requiring a cuff inflation up to 22 cm H2O to maintain a return tidal volume at ≥ 80% delivered. Suction channel performance improved in the lateral position compared with supine for both ETT designs during continuous 15 mm Hg suction pressure (P = .001).
  
  
  CONCLUSIONS
  Within a novel model with normal trachea compliance, we found all ETT designs tested to seal at lower than current recommended cuff pressures.
authors.affiliation: Department of Pediatrics, Virginia Commonwealth University School of Medicine and the Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Rozycki
authors.affiliation: Teleflex Medical, Research Triangle Park, North Carolina.
authors.forename: Fredrick P
authors.initials: FP
authors.lastname: Dixon
authors.affiliation: Department of Pediatrics, Virginia Commonwealth University School of Medicine and the Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Yopp
authors.affiliation: Department of Pediatrics, Virginia Commonwealth University School of Medicine and the Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia. nmaxvold@mcvh-vcu.edu.
authors.forename: Norma J
authors.initials: NJ
authors.lastname: Maxvold
authors.affiliation: Department of Pediatrics, Virginia Commonwealth University School of Medicine and the Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Bruce K
authors.initials: BK
authors.lastname: Rubin
mesh_terms: D004867:Equipment Design; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008953:Models, Anatomic; D011175:Positive-Pressure Respiration; D011312:Pressure; D013396:Suction / Q000295:instrumentation; D013990:Tidal Volume; D014132:Trachea / Q000502:physiology
keywords: compliance; endotracheal tube; insufflation pressure; mucus; suctioning; ventilator-associated pneumonia