• Arch. Otolaryngol. Head Neck Surg. · Jan 2011

    Comparative Study

    Automated cuff pressure modulation: a novel device to reduce endotracheal tube injury.

    • Neil K Chadha, Arie Gordin, Igor Luginbuehl, Greg Patterson, Paolo Campisi, Glenn Taylor, and Vito Forte.
    • Department of Otolaryngology–Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada. nchadha@cw.bc.ca
    • Arch. Otolaryngol. Head Neck Surg. 2011 Jan 1;137(1):30-4.

    ObjectiveTo assess whether dynamically modulating endotracheal tube (ETT) cuff pressure, by decreasing it during each ventilatory cycle instead of maintaining a constant level, would reduce the extent of intubation-related laryngotracheal injury.DesignSingle-blind, randomized controlled animal study using a previously validated live porcine model of accelerated intubation-related tracheal injury.SettingAnimal research facility.PatientsTen piglets (weight, 16-20 kg each) were anesthetized and underwent intubation using a cuffed ETT.InterventionsThe animals were randomized into the following 2 groups: 5 pigs had a novel device to modulate their cuff pressure from 25 cm H₂O during inspiration to 7 cm H₂O during expiration, and 5 pigs had a constant cuff pressure of 25 cm H₂O. Both groups underwent ventilation under hypoxic conditions for 4 hours.Main Outcome MeasureLaryngotracheal mucosal injury after blinded histopathological assessment.ResultsThe modulated-pressure group showed significantly less overall laryngotracheal damage than the constant-pressure group (mean grades, 1.2 vs 2.1; P < .001). Subglottic damage and tracheal damage were significantly less severe in the modulated-pressure group (mean grades, 1.0 vs 2.2; P < .001, and 1.9 vs 3.2; P < .001, respectively). There was no significant difference in glottic or supraglottic damage between the groups (P = .06 and .27, respectively).ConclusionsThis novel device reduces the risk of subglottic and tracheal injury by modulating ETT cuff pressure in synchronization with the ventilatory cycle. This finding could have far-reaching implications for reducing the risk of airway injury in patients undergoing long-term intubation. Further clinical study of this device is warranted.

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