Automated Cuff Pressure Modulation: A Novel Device to Reduce Endotracheal Tube Injury | Medical Devices and Equipment | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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Original Article
January 17, 2011

Automated Cuff Pressure Modulation: A Novel Device to Reduce Endotracheal Tube Injury

Author Affiliations

Author Affiliations: Departments of Otolaryngology–Head and Neck Surgery (Drs Chadha, Gordin, Campisi, and Forte), Anesthesia (Dr Luginbuehl), Medical Engineering (Mr Patterson), and Pathology (Dr Taylor), Hospital for Sick Children, Toronto, Ontario, Canada. Dr Chadha is now with the Division of Pediatric Otolaryngology, BC Children's Hospital, Vancouver, British Columbia, Canada.

Arch Otolaryngol Head Neck Surg. 2011;137(1):30-34. doi:10.1001/archoto.2010.228

Objective  To assess whether dynamically modulating endotracheal tube (ETT) cuff pressure, by decreasing it during each ventilatory cycle instead of maintaining a constant level, would reduce the extent of intubation-related laryngotracheal injury.

Design  Single-blind, randomized controlled animal study using a previously validated live porcine model of accelerated intubation-related tracheal injury.

Setting  Animal research facility.

Patients  Ten piglets (weight, 16-20 kg each) were anesthetized and underwent intubation using a cuffed ETT.

Interventions  The animals were randomized into the following 2 groups: 5 pigs had a novel device to modulate their cuff pressure from 25 cm H2O during inspiration to 7 cm H2O during expiration, and 5 pigs had a constant cuff pressure of 25 cm H2O. Both groups underwent ventilation under hypoxic conditions for 4 hours.

Main Outcome Measure  Laryngotracheal mucosal injury after blinded histopathological assessment.

Results  The modulated-pressure group showed significantly less overall laryngotracheal damage than the constant-pressure group (mean grades, 1.2 vs 2.1; P < .001). Subglottic damage and tracheal damage were significantly less severe in the modulated-pressure group (mean grades, 1.0 vs 2.2; P < .001, and 1.9 vs 3.2; P < .001, respectively). There was no significant difference in glottic or supraglottic damage between the groups (P = .06 and .27, respectively).

Conclusions  This novel device reduces the risk of subglottic and tracheal injury by modulating ETT cuff pressure in synchronization with the ventilatory cycle. This finding could have far-reaching implications for reducing the risk of airway injury in patients undergoing long-term intubation. Further clinical study of this device is warranted.