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Tapered-cuff Endotracheal Tube Does Not Prevent Early Postoperative Pneumonia Compared with Spherical-cuff Endotracheal Tube after Major Vascular Surgery: A Randomized Controlled Trial.
- Source :
-
Anesthesiology . May2016, Vol. 124 Issue 5, p1041-1052. 13p. - Publication Year :
- 2016
-
Abstract
- <bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusion: </bold>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]
- Subjects :
- *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
Subjects
Details
- Language :
- English
- ISSN :
- 00033022
- Volume :
- 124
- Issue :
- 5
- Database :
- Academic Search Index
- Journal :
- Anesthesiology
- Publication Type :
- Academic Journal
- Accession number :
- 114680614
- Full Text :
- https://doi.org/10.1097/ALN.0000000000001053