Assessment of aspiration risk from dynamic modulation of endotracheal tube cuff pressure.

Abstract

OBJECTIVES/HYPOTHESIS: To assess the risk of aspiration using a novel valve circuit that dynamically modulates endotracheal tube cuff pressure during the ventilatory cycle using bench and live animal models. STUDY DESIGN: Animal model. METHODS: The bench model consisted of a cuffed endotracheal tube inserted into an artificial trachea. Leakage of liquid around the cuff was measured after 4 hours of constant or dynamic modulation of cuff pressure at variable peak end expiratory pressures. In the porcine model, eight animals were ventilated with the modulating valve circuit and compared to eight controls ventilated with a constant cuff pressure (25 cm of water). Aspiration was monitored quantitatively using a pH probe (measured as voltage) and visually using fluoroscopy. RESULTS: There was no difference in the amount of fluid leakage around the endotracheal tube cuff in the constant or dynamically modulated pressure-cuff groups in the bench or animal models. CONCLUSION: Dynamically modulating endotracheal tube-cuff pressures to minimize tracheal mucosal damage does not increase the tendency to leak around the cuff compared to endotracheal tube cuffs inflated to a constant pressure. LEVEL OF EVIDENCE: N/A.