A low-volume, low-pressure tracheal tube cuff reduces pulmonary aspiration

Critical Care Medicine
Peter J YoungSriharsha Subramanya

Abstract

Leakage of fluid from the subglottic space to the lungs occurs along the longitudinal folds within the wall of an inflated high-volume, low-pressure (HVLP) cuff. The low-volume, low-pressure (LVLP) cuff does not have these folds yet allows for convenient and reliable control of tracheal wall pressure. Pulmonary aspiration during anesthesia has been linked with postoperative pneumonia and during critical illness causes ventilator-associated pneumonia. Prospective, blinded, randomized controlled trial; prospective observational study; and benchtop models. Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital. Anesthetized patients (n=38) and critically ill patients with either an LVLP or HVLP cuffed tracheostomy tube following swallow assessments (n=67). The LVLP cuff was compared with HVLP cuffs for leakage of dye placed in the subglottic space to the tracheobronchial tree in a rigid tracheal model and a benchtop pig trachea model (before and after a standardized cuff movement). In the rigid tracheal model, the incidence of leakage was 0% in the LVLP group and 100% in the HVLP group (p<.01). Dye leakage in the pig tracheal model with HVLP cuffs was 44% before tube movement, increasing to 79% afterward. The LVLP c...Continue Reading

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