British journal of anaesthesia
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We have assessed a range of high volume, low pressure (HVLP) cuffed tracheal tubes in a benchtop model, for leakage of fluid from above the cuff to the model trachea below, during various ventilatory modes. Rapid leakage occurred in the model during all modes of ventilation, unless tracheal pressure was greater than the height of fluid in the column above the cuff. This leakage occurred preferentially down longitudinal folds that occur in the HVLP cuff wall. This model suggests that, if a longitudinal fold within the cuff wall is patent, then the possibility exists of subglottic to tracheal leakage.
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After acute brain injury there may be increased intracranial production of cytokines, with activation of inflammatory cascades. We have sought to determine if a transcranial cytokine gradient was demonstrable in paired sera of 32 patients requiring intensive care after acute brain injury. ⋯ This suggests that there is significant production of IL-6 by intracranial cells after acute brain injury. Therapy directed towards combatting the negative effects of IL-6 may potentially benefit patients who have sustained an acute brain injury.