443
2012; Lippincott Williams & Wilkins; Volume: 40; Linguagem: Inglês
10.1097/01.ccm.0000424661.27326.5d
ISSN1530-0293
AutoresGianluigi Li Bassi, Eli Aguilera Xiol, Joan Daniel Martí, Montserrat Rigol, Marta Francesca Di Pasquale, Talitha Comaru, Mariano Rinaudo, Ernesto Crisafulli, Néstor Luque, Antoni Torres,
ResumoIntroduction: Novel cuffs made of polyurethane or with a tapered shape were devised to overcome fluid-sealing limitations. However, no studies have assessed potential tracheal injury associated with these cuffs. Hypothesis: We bronchoscopically assessed tracheal injury produced by HVLP cuffs following 72 hours of tracheal intubation and after 24 and 96 hours from extubation. Methods: 16 pigs (Kg 39 ± 3) were intubated with 7.0 ETTs comprising cylindrical, PVC cuffs: ETT1 Ruschelit® Safety Clear plus (2 pigs), ETT2 Hi-LoTM (2 pigs); cylindrical polyurethane cuff: ETT3 Kimvent Microcuff (2 pigs); conical PVC cuffs: ETT4 SacettTM (2 pigs); ETT5 TaperguardTM (3 pigs); ETT6 Sheridan HVT (2 pigs); and conical polyurethane cuff: ETT7 SealGuardTM (3 pigs). Cuff pressure was kept at 28 cm H2O. Images of the tracheal wall were recorded through a fluorescence bronchoscope (SAFE 3000, Pentax, Germany). Normal tracheal regions appeared bluish/greenish; while, injured regions were dark purple/brownish. The red-to-green intensity ratio (R/G) of a region of interest (100x100px) was computed through image analysis software (ImageJ, NIH, USA). The percentage of variation in R/G (?R/G) vs. baseline values was calculated to correct for inter-subject fluorescence variability.The observers were blinded to the treatment group during the analysis Results: The average?R/G (%) at extubation, 24 and 96 hours thereafter was 11.9 ± 12.5, 10.7 ± 11.6 and 6.2 ± 8.0, respectively (Friedman test, N=45, p=0.41). Throughout the study, the?R/G differed among ETTs (Kruskal-Wallis test, N:45, p=0.05): ETT1, 7.1 ± 7.2; ETT2, 8.7 ± 5.4; ETT3, -4.1 ± 2.7; ETT4, 11.0 ± 5.4; ETT5, 9.8 ± 6.6; ETT6, 21.0 ± 15.5; ETT7, 10.0 ± 14.7. The average?R/G of tracheas intubated with PVC and polyurethane cuffs was 12.7 ± 10.1 and -0.6 ± 7.7, respectively (Wilcoxon rank-sum test, N=45, p<0.001); while the mean?R/G with cylindrical and tapered cuffs was 4.7 ± 7.6 and 12.2 ± 11.7 (Wilcoxon rank-sum test, N=45, p=0.06). Conclusions: The design and material of HVLP cuffs are contributing factors to tracheal injury. Polyurethane cylindrical cuffs appear to reduce risks of post-extubation tracheal injury. This work was support by Covidien Ltd, Boulder CO, the manufacturer of Hi-LoTM and TaperguardTM ETTs.
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