Efficiency of a pneumatic device in controlling cuff pressure of polyurethane-cuffed tracheal tubes: a randomized controlled study

BACKGROUND: The primary objective of this study was to determine the efficiency of a pneumatic device in controlling cuff pressure (P(cuff)) in patients intubated with polyurethane-cuffed tracheal tubes. Secondary objectives were to determine the impact of continuous control of P(cuff), and cuff shape on microaspiration of gastric contents. METHODS: Prospective randomized controlled study. All patients requiring intubation and mechanical ventilation ≥48 h were eligible. The first 32 patients were intubated with tapered polyurethane-cuffed, and the 32 following patients were intubated with cylindrical polyurethane-cuffed tracheal tubes. Patients randomly received 24 h of continuous control of P(cuff) using a pneumatic device (Nosten®), and 24 h of routine care of P(cuff) using a manometer. Target P(cuff) was 25 cmH(2)O. P(cuff) was continuously recorded, and pepsin was quantitatively measured in all tracheal aspirates during these periods. RESULTS: The pneumatic device was efficient in controlling P(cuff) (med [IQ] 26 [24, 28] vs 22 [20, 28] cmH(2)O, during continuous control of P(cuff) and routine care, respectively; p = 0.017). In addition, percentage of patients with underinflation (31% vs 68%) or overinflation (53% vs 100%) of tracheal cuff, and percentage of time spent with underinflation (0.9 [0, 17] vs 14% [4, 30]) or overinflation (0 [0, 2] vs 32% [9, 54]) were significantly (p < 0.001) reduced during continuous control of P(cuff) compared with routine care. No significant difference was found in microaspiration of gastric content between continuous control of P(cuff) compared with routine care, or between patients intubated with tapered compared with cylindrical polyurethane-cuffed tracheal tubes. CONCLUSION: The pneumatic device was efficient in controlling P(cuff) in critically ill patients intubated with polyurethane-cuffed tracheal tubes. TRIAL REGISTRATION: The Australian New Zealand Clinical Trials Registry (NCT01351259)