Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Nov 4;26(1):338.
doi: 10.1186/s13054-022-04225-4.

Use of an innovative cuff pressure control and subglottic secretions drainage system in COVID-19 ARDS patients undergoing pronation

Eloisa Sofia Tanzarella  1 , Gianmarco Lombardi  1 , Silvia Baroni  2   3 , Francesca Sarlo  3 , Salvatore Lucio Cutuli  1 , Simone Carelli  1 , Melania Cesarano  1 , Veronica Gennenzi  1 , Gabriele Pintaudi  1 , Joel Vargas  1 , Antonio Maria Dell'Anna  1 , Domenico Luca Grieco  1 , Andrea Urbani  2   3 , Massimo Antonelli  1   3 , Gennaro De Pascale  4   5
Affiliations

Use of an innovative cuff pressure control and subglottic secretions drainage system in COVID-19 ARDS patients undergoing pronation

Eloisa Sofia Tanzarella et al. Crit Care. .

Abstract

We conducted a proof of concept study where Anapnoguard endotracheal tubes and its control unit were used in 15 patients with COVID-19 acute respiratory distress syndrome. Anapnoguard system provides suction, venting, rinsing of subglottic space and controls cuff pressure detecting air leakage through the cuff. Alpha-amylase and pepsin levels, as oropharyngeal and gastric microaspiration markers, were assessed from 85 tracheal aspirates in the first 72 h after connection to the system. Oropharyngeal microaspiration occurred in 47 cases (55%). Episodes of gastric microaspiration were not detected. Patient positioning, either prone or supine, did not affect alpha-amylase and pepsin concentration in tracheal secretions. Ventilator-associated pneumonia (VAP) rate was 40%. The use of the AG system provided effective cuff pressure control and subglottic secretions drainage. Despite this, no reduction in the incidence of VAP has been demonstrated, compared to data reported in the current COVID-19 literature. The value of this new technology is worth of being evaluated for the prevention of ventilator-associated respiratory tract infections.

Keywords: Acute respiratory distress syndrome; Continuous cuff pressure control; Microaspiration; Subglottic secretion drainage; Ventilator-associated pneumonia.

PubMed Disclaimer

Conflict of interest statement

The authors do not have any financial disclosures or conflict of interest.

Figures

Fig. 1
Fig. 1
Per patient alpha-amylase and pepsin levels in supine and prone position
See this image and copyright information in PMC

References

    1. Grasselli G, Scaravilli V, Mangioni D, et al. Hospital-acquired infections in critically Ill patients with COVID-19. Chest. 2021;160(2):454–465. doi: 10.1016/j.chest.2021.04.002. - DOI - PMC - PubMed
    1. Blot SI, Poelaert J, Kollef M. How to avoid microaspiration? a key element for the prevention of ventilator-associated pneumonia in intubated ICU patients. BMC Infect Dis. 2014;28(14):119. doi: 10.1186/1471-2334-14-119. - DOI - PMC - PubMed
    1. Dewavrin F, Zerimech F, Boyer A, et al. Accuracy of alpha amylase in diagnosing microaspiration in intubated critically ill patients. PLoS ONE. 2014;9(6):e90851. doi: 10.1371/journal.pone.0090851. - DOI - PMC - PubMed
    1. Lorente L, Lecuona M, Jiménez A, et al. Influence of an endotracheal tube with polyurethane cuff and subglottic secretion drainage on pneumonia. Am J Respir Crit Care Med. 2007;176(11):1079–1083. doi: 10.1164/rccm.200705-761OC. - DOI - PubMed
    1. De Pascale G, Pennisi MA, Vallecoccia MS, et al. CO2 driven endotracheal tube cuff control in critically ill patients: a randomized controlled study. PLoS ONE. 2017;12(5):e0175476. doi: 10.1371/journal.pone.0175476. - DOI - PMC - PubMed