Impact of Tracheal Cuff Shape on Microaspiration in Intensive Care Units

Conditions

Critical Illness, Mechanical Ventilation Complication, Ventilator Associated Pneumonia

Keywords

tracheal cuff shape, microaspiration, pepsin, ventilator-associated pneumonia

Brief summary

The investigators hypothesized that PVC tapered-cuff tracheal tubes would reduce microaspiration of gastric content as determined by pepsin level in tracheal aspirate.

Detailed description

Microaspiration is the main route for entry of contaminated secretions into the lower respiratory tract of intubated critically ill patients. Tracheobronchial colonization might progress to ventilator-associated pneumonia (VAP) when the quantity and virulence of bacteria are high and when local and general host defenses are weak. Recent in vitro and animal studies suggest that tapered-cuff tracheal tubes could be associated with reduced microaspiration of contaminated secretions and might be helpful in preventing VAP.

Jaillette E, Girault C, Brunin G, Zerimech F, Behal H, Chiche A, Broucqsault-Dedrie C, Fayolle C, Minacori F, Alves I, Barrailler S, Labreuche J, Robriquet L, Tamion F, Delaporte E, Thellier D, Delcourte C, Duhamel A, Nseir S, BestCuff Study Group and the BoRéal Network.

2017-03-1643 citations

10.1007/s00134-017-4736-x

Impact of tracheal cuff shape on microaspiration of gastric contents in intubated critically ill patients: study protocol for a randomized controlled trial

Emmanuelle Jaillette, Guillaume Brunin, Christophe Girault, Farid Zerimech, Arnaud Chiche et al. (17 authors)

Trials2015-09-2523 citations

10.1186/s13063-015-0955-z

Interventions

DEVICEtapered PVC-cuffed tracheal tubes

Patients will be intubated with tapered-shape tracheal tubes

DEVICEStandard PVC-cuffed tracheal tube

Patients will be intubated with standard PVC cuffed tracheal tubes

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

TREATMENT

Masking

SINGLE (Outcomes Assessor)

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

No

Inclusion criteria

* age \> or = 18 years * tracheal intubation * predictable duration of mechanical ventilation \> 48h * enteral nutrition

Exclusion criteria

* pregnant women * refuse to participate to the study * no informed consent * contre indication for semirecumbent position

Design outcomes

Primary

Measure	Time frame	Description
Microaspiration of gastric contents	48 hours after randomization	Mesuerment of pepsin level in tracheal aspirate will be used to quantify microaspiration of gastric contents

Secondary

Measure	Time frame	Description
Microaspiration of oropharyngeal secretions	48 h after randomization	amylase level on tracheal aspirate would allow to quantify microaspiration of oropharyngeal secretions
Tracheobronchial colonization	28 days after randomization	—
Ventilator-associated pneumonia	28 days after randomization	—

Countries

France

Outcome results

None listed