Current endotracheal and tracheostomy tubes have high volume low pressure cuffs. These cuffs are ineffective at preventing the ongoing pulmonary aspiration of oropharyngeal and gastric contents. This ubiquitous complication of intubation is the most important cause of ventilator-associated pneumonia (VAP), the commonest and most devastating nosocomial infection in the Intensive Care Unit (ICU). Current tracheal tubes are made of relatively fixed curved PVC, and this produces forces on the airway tissues which is associated with laryngeal and tracheal injury. There is a need for the development of tracheal tube technologies to prevent aspiration injury and the reduce airway injury associated with mechanical ventilation of the critically ill. Given the costs associated with VAP there is currently a massive mismatch in what we spend on prevention.
Adair CG, Gorman SP, Feron BM, et al. 1999. Implications of endotracheal tube biofilm for ventilator-associated pneumonia. Intensive Care Med25: 1072-76.
2.
Anderson DJ, Kirkland KB, Kaye KS, Thacker Paii, Kanafani ZA, Auten G., Sexton DJ2007. Underresourced hospital infection control and prevention programs: penny wise, pound foolish?Infect Control Hosp Epidemiol28: 767-73.
3.
Bernhard WN, Cottrell JE, Sivakumaran C., Patel K., Yost L., Turndorf H.1979. Adjustment of intracuff pressure to prevent aspiration . Anaesthesiology50: 363-66.
4.
Berra L., Curto F., LiBassi G., Laquerriere P., Baccarelli A., Kolobow T.2006. Antibacterial - coated tracheal tubes cleaned with the mucus shaver: a novel method to retain long term bactericidal activity of coated tracheal tubes. Intensive Care Med32: 888-93.
5.
Berra L., De Marchi L., Panigada M., Yu ZX, Baccarelli A., Kolobow T.2004a. Evaluation of continuous aspiration of subglottic secretion in an in vivo study. Crit Care Med32: 2071-78.
6.
Berra L., De Marchi L., Yu ZX, Laquerririere P., Baccarelli A., Kolobow T.2004b. Endotracheal tubes coated with antiseptics decrease bacterial colonisation of the ventilator circuits, lungs and endotracheal tube. Anaesthesiology100: 1446-56.
7.
Blanch PB2004. Laboratory evaluation of 4 brands of endotracheal tube cuff inflator. Resp Care49: 166-73.
8.
Blunt MC, Patil A., Young PJ, Haddock A.2001. Gel lubrication of the tracheal cuff reduces pulmonary aspiration. Anaesthesiology95(21): 377-81.
9.
CDC.2003. Guidelines for preventing healthcare-associated pneumonia, 2003 recommendations of the CDC and the Healthcare Infection Control Practices Advisory Committee. Respir Care49: 926-39.
10.
Cohen IL, Weinberg PF, Fein IA, Rowinski GS1988. Endotracheal tube occlusion associated with the use of heat and moisture exchangers in the intensive care unit. Crit Care Med16: 277-79.
11.
Cook D., Guyatt G., Marshall J., et al. (Canadian Critical Care Trials Group).1998. A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation . NEJM338: 791-97.
12.
de Lassence A., Alberti C., Azoulay E., et al. 2002. OUTCOMEREA Study Group, Impact of unplanned extubation and reintubation after weaning on nosomical pneumonia risk in the intensive care unit: a prospective multicenter study. Aneasthesiology97: 148-56.
13.
Dezfulian C., Shojania K., Collard HR, Kim HM, Matthay MA, Saint S.2005. Subglottic secretion drainage for preventing ventilator associated pneumonia: a meta-analysis. Am J Med118: 11-8.
14.
Diaz E., Rodriguez AH, Rello J.2005. Ventilator-associated pneumonia: issues related to the artificial airway. Resp Care50: 900-06.
15.
Dragoumanis CK, Vretzakis GI, Papaioannou VE, Didilis VN, Vogiatzaki TD, Pneumatikos IA2007. Investigating the failure to aspirate subglottic secretions with the Evac endotracheal tube. Anesth Analg105: 1083-85.
16.
Drakulovic MB, Torres A., Bauer TT, Nicolas JM, Nogué S., Ferrer M.1999. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet354: 1851-58.
17.
Dullenkopf A., Kretschmar O., Knirsch W., et al. 2006. Comparison of tracheal cuff diameters with internal transverse diameters of trachea in children. Acta-anaesthesiol Scand50: 201-05.
18.
Elliot MW2005. Non-invasive ventilation for acute respiratory disease . Br Med Bull72: 83-97.
19.
Estes RJ, Meduri GU1995. The pathogenesis of ventilator- associated pneumonia: Mechanisms of bacterial transcolonization and airway inoculation. Intensive Care Med21: 365-83.
20.
Evans LA, Young PJ2007. Preventing iatrogenic air embolism in the intensive care unit. Med Device Technol18: 36-7.
21.
Feldman C., Kassel M., Cantrell J., Kaka S., Morar R., Goolam Mahomed A., Philips J.1999. The presence and sequence of endotracheal tube colonization in patients undergoing mechanical ventilation. Eur Respir J13: 546-51.
22.
Galinski M., Treoux V., Garrigue B., Lapostolle F., Borron SW, Adnet F.2006. Intracuff pressures of endotracheal tubes in the management of airway emergencies: the need for pressure monitoring. Ann Emerg Med47: 545-47.
23.
Gastmeier P., Geffers C.2007. Prevention of ventilator-associated pneumonia: analysis of studies published since 2004. J Hosp Infect67: 1-8.
24.
Girou E., Buu-Hoi A., Stephan F., Novara A., Gutmann L., Safar M., Fagon JY2004. Airway colonisation in long-term mechanically ventilated patients. Effect of semi-recumbent position and continuous subglottic suctioning . Intensive Care Med30: 225-33.
25.
Holzapfel L.2003. Nasal vs oral intubation. Minerva Anaesthesiol69: 348-52.
26.
Kastanos N., Estopa Miro R., Marin Perez A., Xaubet Mir A., Agusti-Vidal A.1983. Laryngotracheal injury due to endo tracheal intubation: incidence, evolution, and predisposing factors. A prospective long term study . Crit Care Med11: 362-67.
27.
Koerner RJ1997. Contribution of endotracheal tubes to the pathogenesis of ventilator-associated pneumonia. J Hosp Infect35: 83-9.
28.
Kollef M.2004. The relationship between pathogenesis and prevention strategies for VAP. Crit Care Med32: 1396-1405.
29.
Kolobow T., LiBassi G., Curto F., Zanella A.2006. The mucus slurper: a novel tracheal tube that requires no tracheal tube suctioning. Intensive Care Med32: 1414-18.
30.
Kolobow T., Berra L., LiBassi G., Curto F.2005. Novel system for complete removal of secretions within the endotracheal tube: the mucus shaver. Anaesthesiology102: 1063-65.
31.
Leverment JN, Pearson FG1977. Tracheal damage associated with cuffed tracheostomy tubes, Aspiration of gastric content as a cause of local damage in tracheostomised dogs. Anaesthesia32: 603-13.
32.
Lorente L., Lecuona M., Jimenez A., Mora MC, Sierra A.2007. Influence of an Endotracheal Tube with polyurethane cuff and subglottic drainage in pneumonia. Am J Respir Crit Care Med176: 1079-83.
33.
Lovett PB, Flaxman A., Sturmann KM, Bijur P.2006. The insecure airway: a comparison of knots and commercial devices for securing endotracheal tubes. BMC Emerg Med6: 7.
34.
Metheny NA, Clouse RE, Chang YH, Stewart BJ, Oliver DA, Kollef MH2006. Tracheobronchial aspiration of gastric contents in critically ill tube fed patients: frequency, outcomes, and risk factors . Crit Care Med34: 1007-15.
35.
Mol DA, De VilliersGdu T., Claassen AJ, Joubert G.2004. Use and care of an endo tracheal/tracheostomy tube cuff- are intensive care unit staff adequately informed? S Afr J Surg42: 14-6.
36.
Olsen ME, Harmon BG, Kollef MH2002. Silver coated endotracheal tubes associated with reduced bacterial burden in the lungs of mechanically ventilated dogs. Chest121: 863-70.
37.
Paegle RD, Bernhard WN1975. Squamous metaplasia of tracheal epithelium; associated with high-volume, low pressure airway cuffs. Anaesth Analg54: 340-44.
38.
Patel N., Smith CE, Pinchak AC, Hancock DE1997. Taping methods and tape types for securing oral endotracheal tubes. Can J anaesth44: 330-36.
39.
Pavlin EG, VanNimwegan D., Hornbein TF1975. Failure of a high compliance low pressure cuff to prevent aspiration. Anaesthesiology42: 216-19.
40.
Rello J., Kollef M., Diaz E., et al. 2006. Reduced burden of bacterial airway colonization with a novel silver coated endotracheal tube in a randomised multiple centre feasibility study. Crit Care Med34: 2766-72.
41.
Rello J., Sonora R., Jubert P., Artigas A., Rue M., Valles J.1996. Pneumonia in intubated patients: role of respiratory airway care. Am J Respir Crit Care Med154: 111-15.
42.
Safdar N., Dezfulian C., Collard HR, Saint S.2005. Clinical and economic consequences of ventilator associated pneumonia: a systematic review. Crit Care Med33: 2184-93.
43.
Sathishkumar S., Young P.2002. Tracheal cuff pressure-a survey of clinical practise . Br J Anaesth88: 456.
44.
Seeglobin RD, van Hasselt GL1984. Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs. Br Med J (Clin Res Ed)288: 965-68.
Shah C., Kollef MH2004. Endotracheal intraluminal volume loss among mechanically ventilated patients. Crit Care Med32: 120-25.
47.
Shorr AF, Wunderink RG2003. Dollars and sense in the intensive care unit: the costs of ventilator-associated pneumonia. Crit Care Med31: 1582-83.
48.
Siobal M., Kallet RH, Kraemer R., et al. 2001. Tracheal - innominate artery fistula caused by the endotracheal tube tip: case report and investigation of a fatal complication of prolonged intubation. Resp Care46: 1012-18.
49.
Takara I., Fukuda A., Koja H., Tomiyama H., Tokumine J., Sugahara K.2004. Unanticipated endotracheal tube displacement in a short neck patient with a history of chronic rheumatoid arthritis. Masui53: 1180-84.
50.
Trawoger R., Kolobow T., Cereda M., Sparacino ME1997. Tracheal mucus velocity remains normal in healthy sheep intubated with a new endotracheal tube with a novel laryngeal seal. Anaesthesiology86: 1140-44.
51.
Valencia M., Ferrer M., Farre R., Navajas D., Badia JR, Nicolas JM, Torres A.2007. Automatic control of tracheal tube cuff pressure in ventilated patients in semirecumbent position: a randomized trial. Crit Care Med35: 1543-49.
52.
van Nieuwenhoven CA, Vandenbroucke-Grauls C., van Tiel FH, Joore HC, van Schijndel RJ, van der Tweel I., Ramsay G., Bonten MJ2006. Feasibility and effects of the semirecumbent position to prevent ventilator-associated pneumonia: a randomized study. Crit Care Med34: 396-402.
53.
Vincent JL, Bihari DJ, Suter PM, et al. 1995. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA274: 649-44.
54.
Young PJ, Pakeerathan S., Blunt MC, Subramanya S.2006. A low-volume, low pressure tracheal tube cuff reduces pulmonary aspiration. Crit Care Med34: 632-39.
55.
Young PJ, Rollinson M., Downward G., Henderson S.1997. Leakage of fluid past the tracheal tube cuff in a benchtop model. Br J Anaesth78: 557-62.
