Comparing the effect of polyurethane endotracheal tube and polyurethane subglottic secretion drainage endotracheal tube on fluid leakage across endotracheal tube cuff as a measure for preventing microaspiration to reduce ventilator associated pneumonia: A laboratory study
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摘要Background: Ventilator Associated Pneumonia (VAP) can result in many adverse patient outcome including an
increase in length of stay, mortality, and hospital cost. One major factor contributing to VAP is pulmonary aspiration.
Endotracheal tube intervention (including special ETT cuff material) is one of the many interventions for minimizing
pulmonary aspiration, but its evidence is still inconclusive. Meta-analysis result showed that Polyurethane ETT
(PU-ETT) reduced VAP significantly as compared to conventional ETT, but its generalizability was limited due to its
small number of included studies as well as the heterogeneity in its ETT function.

Aim of Pilot Study: In view of the
difficulty to access human subjects, a bench top study was planned to compare the effect of these two ETTs on fluid
leak across the ETT cuff. This laboratory study employed a 2x3x2x2 full factorial experimental design to compare the
effect of PU-ETT and PU-SSD-ETT on fluid leakage across ETT cuff with the control of the potential effects of positive end expiratory pressure (PEEP), ETT cuff pressure (CuffP) and oral care (OC). Methodology: Airway manikins and size 7.5 ETT of both types were used. Each type of ETT was tested through 12 scenarios with combinations of different PEEP level, ETT cuff pressure and oral care. The Generalized Linear Model and Generalized Estimating Equation were used to analyze fluid leak (with and without interaction effect). Statistical significance cut-off point was p<0.05. Key Findings: . Results showed that PU-SSD-ETT has significant effect in minimizing fluid leak than PU-ETT (Wald χ2 =191.108; p<0.001). PEEP showed a significant effect on fluid leak with PEEP-10 vs PEEP-0 (Wald χ2 =944.850; p<0.001). CuffP 25 showed less fluid leak than CuffP-15 (Wald χ2 =841.695; p<0.001). Performing OC showed more fluid leak than without OC (Wald χ2 =187.865; p<0.001). Tube type and PEEP showed the interaction effect in minimizing fluid leak (Wald χ2 =155.675; p<0.001).

Conclusion: This laboratory study demonstrated that PU-SSD-ETT consistently outperforms the PU-ETT in minimizing fluid leak after controlling the effects of PEEP, CuffP and OC. High PEEP exerts better effect in minimizing fluid leak than low PEEP and no PEEP. Normal ETT CuffP is important in minimizing fluid leak in most scenarios. Tooth-brushing can cause ETT movement, and affect the ETT cuff seal. Combining PU-SSD-ETT and high PEEP may have a better synergistic effect in minimizing fluid leak.
著者CHAN Wing Keung David, CHAIR Sek Ying, LEUNG Yin Ping
會議名稱Sixth Pan-Pacific Nursing Conference and First Colloquium on Chronic Illness Care: Achieving Transformational and Sustainable Development in Health and Social Care
會議地點Hong Kong

上次更新時間 2018-20-01 於 14:01