title: Tapered-cuff Endotracheal Tube Does Not Prevent Early Postoperative Pneumonia Compared with Spherical-cuff Endotracheal Tube after Major Vascular Surgery: A Randomized Controlled Trial.
abstract: BACKGROUND
  Patients undergoing major vascular surgery often develop postoperative pneumonia that impacts their outcomes. Conflicting data exist concerning the potential benefit of tapered-shaped cuffs on tracheal sealing. The primary objective of this study was to assess the efficiency of a polyvinyl chloride tapered-cuff endotracheal tube at reducing the postoperative pneumonia rate after major vascular surgery. Secondary objectives were to determine its impact on microaspiration, ventilator-associated pneumonia rate, and inner cuff pressure.
  
  
  METHODS
  This prospective randomized controlled study included 109 patients who were randomly assigned to receive either spherical- (standard cuff) or taper-shaped (tapered cuff) endotracheal tubes inserted after anesthesia induction and then admitted to the intensive care unit after major vascular surgery. Cuff pressure was continuously recorded over 5 h. Pepsin and α-amylase concentrations in tracheal aspirates were quantified on postoperative days 1 and 2. The primary outcome was the early postoperative pneumonia frequency.
  
  
  RESULTS
  Comparing the tapered-cuff with standard-cuff group, respectively, postoperative pneumonia rates were comparable (42 vs. 44%, P = 0.87) and the percentage (interquartile range) of cuff-pressure time with overinflation was significantly higher (16.1% [1.5 to 50] vs. 0.6% [0 to 8.3], P = 0.01), with a 2.5-fold higher coefficient of variation (20.2 [10.6 to 29.4] vs. 7.6 [6.2 to 10.2], P < 0.001). Although microaspiration frequencies were high, they did not differ between groups.
  
  
  CONCLUSIONS
  For major vascular surgery patients, polyvinyl chloride tapered-cuff endotracheal tubes with intermittent cuff-pressure control did not lower the early postoperative pneumonia frequency and did not prevent microaspiration.
authors.affiliation: From the Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, UPMC Université, Paris, France (A.M., Q.L., M.L.C., H.B., C.A., C.V., M.-H.F., C.I.-E., O.L., J.-J.R.); Department of Biochemistry and Molecular Biology of the Centre de Biologie Pathologie, CHRU Lille, Lille University, Faculty of Pharmacy, Lille, France (F.Z., M.B.); Department of Adult Intensive Care, Mãe de Deus Hospital and Moinhos de Vento Hospital, and Graduate Program in Respiratory Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (F.D.); and Department of Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China (C.W.).Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, FranceMultidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, FranceMultidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, FranceMultidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, FranceMultidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, FranceMultidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, FranceClinical Research Department, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, FranceDepartment of Vascular Surgery, La Pitié-Salpêtrière Hospital, Assistance Publique
authors.forename: Antoine
authors.initials: A
authors.lastname: Monsel
authors.forename: Qin
authors.initials: Q
authors.lastname: Lu
authors.forename: Marine
authors.initials: M
authors.lastname: Le Corre
authors.forename: Hélène
authors.initials: H
authors.lastname: Brisson
authors.forename: Charlotte
authors.initials: C
authors.lastname: Arbelot
authors.forename: Corinne
authors.initials: C
authors.lastname: Vezinet
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Fléron
authors.forename: Christina
authors.initials: C
authors.lastname: Ibanez-Estève
authors.forename: Farid
authors.initials: F
authors.lastname: Zerimech
authors.forename: Malika
authors.initials: M
authors.lastname: Balduyck
authors.forename: Felippe
authors.initials: F
authors.lastname: Dexheimer
authors.forename: Chunyao
authors.initials: C
authors.lastname: Wang
authors.forename: Olivier
authors.initials: O
authors.lastname: Langeron
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Rouby
authors.forename: Liliane
authors.initials: L
authors.lastname: Bodin
authors.forename: Romain
authors.initials: R
authors.lastname: Deransy
authors.forename: Pierre
authors.initials: P
authors.lastname: Garçon
authors.forename: Hatem
authors.initials: H
authors.lastname: Douiri
authors.forename: Ismael
authors.initials: I
authors.lastname: Khalifa
authors.forename: Antoine
authors.initials: A
authors.lastname: Pons
authors.forename: Wen-Jie
authors.initials: WJ
authors.lastname: Gu
authors.forename: Fabien
authors.initials: F
authors.lastname: Koskas
authors.forename: Julien
authors.initials: J
authors.lastname: Gaudric
mesh_terms: D000368:Aged; D004867:Equipment Design; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D010434:Pepsin A / Q000032:analysis; D011014:Pneumonia / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D011015:Pneumonia, Aspiration / Q000517:prevention & control; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control; D011183:Postoperative Complications / Q000382:microbiology / Q000517:prevention & control*; D011312:Pressure; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D000516:alpha-Amylases / Q000032:analysis
chemical_list: D000516:alpha-Amylases; D010434:Pepsin A