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Correspondence |

Does Cuff Material and Design Help Prevent Ventilator-Associated Pneumonia?Cuff Material and Design FREE TO VIEW

Jan Poelaert, MD, PhD, FCCP
Author and Funding Information

From the Department of Anesthesiology and Perioperative Medicine, University Hospital-Free University of Brussels.

Correspondence to: Jan Poelaert, MD, PhD, FCCP, Department of Anesthesiology and Perioperative Medicine, University Hospital-Free University of Brussels, Laarbeeklaan 101, B1090, Brussels, Belgium; e-mail: Jan.poelaert@uzbrussel.be


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(5):1358-1359. doi:10.1378/chest.12-1806
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Published online

To the Editor:

I read with great interest the clinical review on new technologies with respect to endotracheal tubes by Fernandez et al1 in CHEST (July 2012). These authors provided a complete overview of the techniques available for the prevention of ventilator-associated pneumonia.

One major objection has to be made concerning the reference to a published study by our group, in which postoperative cardiac surgical patients were intubated with either a polyvinylchloride (PVC) cuffed or a polyurethane (PU) cuffed endotracheal tube.2 A major difference in the rate of postoperative pneumonia was indeed described. In contrast to what was stated in the review, we compared a barrel-shaped, not a tapered-shaped, cuffed endotracheal tube made of either PVC or PU. This is important because the findings of this study support and extend the data of Lorente et al,3 combining the barrel-shaped PU cuffed endotracheal tube with subglottic aspiration. Tapered-shaped PVC cuffed endotracheal tubes have been assessed in in vitro studies, and they have suggested a slower descent of dye solution, in contrast to barrel-shaped PVC cuffed tubes.4 To our knowledge, no study has examined the characteristics of a tapered-shaped PU cuff in a clinical setting.

Fernandez JF, Levine SM, Restrepo MI. Technologic advances in endotracheal tubes for prevention of ventilator-associated pneumonia. Chest. 2012;142(1):231-238. [CrossRef] [PubMed]
 
Poelaert J, Depuydt P, De Wolf A, Van de Velde S, Herck I, Blot S. Polyurethane cuffed endotracheal tubes to prevent early postoperative pneumonia after cardiac surgery: a pilot study. J Thorac Cardiovasc Surg. 2008;135(4):771-776. [CrossRef] [PubMed]
 
Lorente L, Lecuona M, Jiménez A, Mora ML, Sierra A. Influence of an endotracheal tube with polyurethane cuff and subglottic secretion drainage on pneumonia. Am J Respir Crit Care Med. 2007;176(11):1079-1083. [CrossRef] [PubMed]
 
Zanella A, Scaravilli V, Isgrò S, et al. Fluid leakage across tracheal tube cuff, effect of different cuff material, shape, and positive expiratory pressure: a bench-top study. Intensive Care Med. 2011;37(2):343-347. [CrossRef] [PubMed]
 

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References

Fernandez JF, Levine SM, Restrepo MI. Technologic advances in endotracheal tubes for prevention of ventilator-associated pneumonia. Chest. 2012;142(1):231-238. [CrossRef] [PubMed]
 
Poelaert J, Depuydt P, De Wolf A, Van de Velde S, Herck I, Blot S. Polyurethane cuffed endotracheal tubes to prevent early postoperative pneumonia after cardiac surgery: a pilot study. J Thorac Cardiovasc Surg. 2008;135(4):771-776. [CrossRef] [PubMed]
 
Lorente L, Lecuona M, Jiménez A, Mora ML, Sierra A. Influence of an endotracheal tube with polyurethane cuff and subglottic secretion drainage on pneumonia. Am J Respir Crit Care Med. 2007;176(11):1079-1083. [CrossRef] [PubMed]
 
Zanella A, Scaravilli V, Isgrò S, et al. Fluid leakage across tracheal tube cuff, effect of different cuff material, shape, and positive expiratory pressure: a bench-top study. Intensive Care Med. 2011;37(2):343-347. [CrossRef] [PubMed]
 
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