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. 2014 Oct-Dec;29(4):552-8.
doi: 10.5935/1678-9741.20140096.

Effectiveness of the endotracheal tube cuff on the trachea: physical and mechanical aspects

Maira Soliani Del Negro  1 , Gilson Barreto  2 , Raíssa Quaiatti Antonelli  1 , Tiago Antônio Baldasso  1 , Luciana Rodrigues de Meirelles  1 , Marcos Mello Moreira  1 , Alfio José Tincani  1
Affiliations

Effectiveness of the endotracheal tube cuff on the trachea: physical and mechanical aspects

Maira Soliani Del Negro et al. Rev Bras Cir Cardiovasc. 2014 Oct-Dec.

Abstract
in English, Portuguese

Introduction: The inflation pressure of the endotracheal tube cuff can cause ischemia of the tracheal mucosa at high pressures; thus, it can cause important tracheal morbidity and tracheal microaspiration of the oropharyngeal secretion, or it can even cause pneumonia associated with mechanical ventilation if the pressure of the cuff is insufficient.

Objective: In order to investigate the effectiveness of the RUSCH® 7.5 mm endotracheal tube cuff, this study was designed to investigate the physical and mechanical aspects of the cuff in contact with the trachea.

Methods: For this end, we developed an in vitro experimental model to assess the flow of dye (methylene blue) by the inflated cuff on the wall of the artificial material. We also designed an in vivo study with 12 Large White pigs under endotracheal intubation. We instilled the same dye in the oral cavity of the animals, and we analyzed the presence or not of leakage in the trachea after the region of the cuff after their deaths (animal sacrifice). All cuffs were inflated at the pressure of 30 cmH2O.

Results: We observed the passage of fluids through the cuff in all in vitro and in vivo experimental models.

Conclusion: We conclude that, as well as several other cuff models in the literature, the RUSCH® 7.5 mm tube cuffs are also not able to completely seal the trachea and thus prevent aspiration of oropharyngeal secretions. Other prevention measures should be taken.

Introdução: A pressão de insuflação do balonete (cuff) do tubo endotraqueal tanto pode causar isquemia de mucosa traqueal em pressões elevadas, e assim ocasionar morbidade traqueal importante, quanto pode causar microaspiração traqueal de secreção de orofaringe ou, ainda, ocasionar pneumonia associada à ventilação mecânica, caso a pressão do balonete seja insuficiente.

Objetivo: A fim de investigar a eficácia do balonete do tubo endotraqueal RUSCH® 7,5mm, este estudo foi desenhado para investigar aspectos físicos e mecânicos do balonete em contato com a traqueia.

Métodos: Para isto, foi desenvolvido modelo experimental in vitro para avaliar o escoamento de corante (azul de metileno) pelo balonete insuflado na parede de material artificial. Também foi desenhado estudo in vivo com 12 porcos da raça Large-White sob intubação endotraqueal. Foi instilado o mesmo corante na cavidade oral do animal e após óbito (sacrifício do animal) foi analisada a presença ou não de vazamento deste na traqueia pós-região do balonete. Todos os balonetes foram insuflados na pressão de 30 cmH2O.

Resultados: Houve passagem de fluidos pelo balonete em todos os modelos experimentais in vitro e in vivo.

Conclusão: Podemos concluir que, assim como diversos outros modelos de balonetes na literatura, balonetes do tubo RUSCH® 7,5mm também não são capazes de vedar completamente a traqueia e com isso prevenir aspiração de secreções orofaríngeas. Outras medidas para a prevenção devem ser tomadas.

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Figures

Fig.1
Fig.1
Cross-sectional area of the tube (A) demonstrates its outer ring and inner cuff. Item B corresponds to the format of the trachea and its perimeter. (C) Cross-sectional area of the endotracheal tube adapted to the tracheal lumen with redundancy channels formed, which can allow the passage of fluids.
Fig. 2
Fig. 2
Porcine trachea isolated with a tracheal tube with cuff (*) inflated at 30cmH2O pressure. The blue dye was introduced in the (proximal) upper region of the inflated cuff. After four minutes, the dye had leaked around the cuff (arrow).
See this image and copyright information in PMC

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