1. Tapered-cuff Endotracheal Tube Does Not Prevent Early Postoperative Pneumonia Compared with Spherical-cuff Endotracheal Tube after Major Vascular Surgery: A Randomized Controlled Trial.
- Author
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Monsel, Antoine, Qin Lu, Le Corre, Marine, Brisson, Hélène, Arbelot, Charlotte, Vezinet, Corinne, Fléron, Marie-Hélène, Ibanez-Estève, Christina, Zerimech, Farid, Balduyck, Malika, Dexheimer, Felippe, Chunyao Wang, Langeron, Olivier, Rouby, Jean-Jacques, Lu, Qin, Wang, Chunyao, Bodin, Liliane, Deransy, Romain, Garçon, Pierre, and Douiri, Hatem
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PNEUMONIA prevention , *ASPIRATION pneumonia , *TRACHEA intubation , *VENTILATOR-associated pneumonia , *AMYLASES , *CARDIOVASCULAR surgery , *COMPARATIVE studies , *LONGITUDINAL method , *RESEARCH methodology , *MEDICAL cooperation , *PEPSIN , *PNEUMONIA , *PRESSURE , *RESEARCH , *SURGICAL complications , *PRODUCT design , *EVALUATION research , *RANDOMIZED controlled trials , *TREATMENT effectiveness , *BLIND experiment , *PREVENTION , *EQUIPMENT & supplies ,PREVENTION of surgical complications - Abstract
Background: Patients undergoing major vascular surgery often develop postoperative pneumonia that impacts their outcomes. Conflicting data exist concerning the potential benefit of tapered-shaped cuffs on tracheal sealing. The primary objective of this study was to assess the efficiency of a polyvinyl chloride tapered-cuff endotracheal tube at reducing the postoperative pneumonia rate after major vascular surgery. Secondary objectives were to determine its impact on microaspiration, ventilator-associated pneumonia rate, and inner cuff pressure.Methods: This prospective randomized controlled study included 109 patients who were randomly assigned to receive either spherical- (standard cuff) or taper-shaped (tapered cuff) endotracheal tubes inserted after anesthesia induction and then admitted to the intensive care unit after major vascular surgery. Cuff pressure was continuously recorded over 5 h. Pepsin and α-amylase concentrations in tracheal aspirates were quantified on postoperative days 1 and 2. The primary outcome was the early postoperative pneumonia frequency.Results: Comparing the tapered-cuff with standard-cuff group, respectively, postoperative pneumonia rates were comparable (42 vs. 44%, P = 0.87) and the percentage (interquartile range) of cuff-pressure time with overinflation was significantly higher (16.1% [1.5 to 50] vs. 0.6% [0 to 8.3], P = 0.01), with a 2.5-fold higher coefficient of variation (20.2 [10.6 to 29.4] vs. 7.6 [6.2 to 10.2], P < 0.001). Although microaspiration frequencies were high, they did not differ between groups.Conclusion: For major vascular surgery patients, polyvinyl chloride tapered-cuff endotracheal tubes with intermittent cuff-pressure control did not lower the early postoperative pneumonia frequency and did not prevent microaspiration. [ABSTRACT FROM AUTHOR]- Published
- 2016
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