Comparison of Prophylactic Effects of Polyurethane Cylindrical or Tapered Cuff and Polyvinyl Chloride Cuff Endotracheal Tubes on Ventilator-Associated Pneumonia


Because microaspiration of contaminated supraglottic secretions past the endotracheal tube cuff is considered to be central in the pathogenesis of pneumonia, improved design of tracheal tubes with new cuff material and shape have reduced the size and number of folds, which together with the addition of suction ports above the cuff to drain pooled subglottic secretions leads to reduced aspiration of oropharyngeal secretions. So we conducted a study to compare the prophylactic effects of polyurethane-cylindrical or tapered cuff and polyvinyl chloride cuff endotracheal tubes (ETT) on ventilator-associated pneumonia. This randomized clinical trial was carried out in a 12 bed surgical intensive care unit. 96 patients expected to require mechanical ventilation more than 96 hours were randomly allocated to one of three following groups: Polyvinyl chloride cuff (PCV) ETT, Polyurethane (PU) cylindrical Sealguard ETT and PU Taperguard ETT. Cuff pressure monitored every three hours 3 days in all patients. Mean cuff pressure didn't have significant difference between three groups during 72 hours. Pneumonia was seen in 11 patients (34%) in group PVC, 8 (25%) in Sealguard and 7 (21%) in Taperguard group. Changes in mean cuff pressure between Sealguard and PVC tubes and also between Taperguard and PVC tubes did not show any significant difference. There was no significant difference in overinflation between three groups. The use of ETT with PU material results in reducing ventilator-associated pneumonia compared to ETT with PVC cuff. In PU tubes Taperguard has less incidence of ventilator-associated pneumonia compared to Sealguard tubes.

Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002;165(7):867–903.

Craven DE, Steger KA. Epidemiology of nosocomial pneumonia: New concepts on an old disease. Chest 1995;108(2 Suppl):1S–16S.

Kollef MH. Prevention of hospital associated pneumonia and ventilator associated pneumonia. Crit Care Med2004;32(6):1396–404.

Mahul P, Auboyer C, Jospe R, Ros A, Guerin C, el Khouri Z, Galliez M, Dumont A, Gaudin O. Prevention of nosocomial pneumonia in intubated patients: Respective role of mechanical subglottic secretions drainage and stress ulcer prophylaxis. Intensive Care Med 1992;18(1):20–5.

Torres A, Serra-Batlles J, Ros E, Piera C, Puig de laBellacasa J, Cobos A, Lomen˜a F, Rodrı´guez-Roisin R. Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: The effect of body position. Ann Intern Med 1992;116(7):540–3.

Valle´s J, Artigas A, Rello J, Bonsoms N, Fontanals D, Blanch L, Ferna´ndez R, Baigorri F, Mestre J. Continuous aspiration of subglottic secretions in preventing ventilatorassociated pneumonia. Ann Intern Med 1995;122(3):179–86.

Smulders K, van den Hoeven H, Weers-Pothoff J, Vandenbroucke-Grauls C. A randomized clinical trial of intermittent subglottic secretion drainage in patients receiving mechanical ventilation. Chest 2002;121(3):858–62.

Dezfulian C, Shojania K, Collard HR, Kim HM, Matthay MA, Saint S. Subglottic secretion drainage for preventing,ventilator-associated pneumonia: A meta-analysis. Am J Med 2005;118(1):11–8.

Pineda LA, Saliba RG, El Solh AA. Effect of oral decontamination with chlorhexidine on the incidence of nosocomial pneumonia: a meta-analysis. Crit Care 2006;10(1):R35.

Pneumatikos I, Koulouras V, Nathanail C, Goe D, NakosG. Selective decontamination of subglottic area in mechanically ventilated patients with multiple trauma. Intensive Care Med 2002;28(4):432–7.

Kolobow T, Berra L, Li Bassi G, Curto F. Novel system for complete removal of secretions within the endotracheal tube: The Mucus Shaver. Anesthesiology 2005;102(5):1063–5.

Berra l, Curto F, Li Bassi G, Laquerriere P, Baccarelli A, Kolobow T. Antibacterial-coated tracheal tubes cleaned with the Mucus Shaver. A novel method to retain longterm bactericidal activity of coated tracheal tubes. Intensive Care Med 2006;32(6):888–93.

Gorman SP, Adair CG, O’Neill FB, Goldsmith EC, Webb CH. Influence of selective decontamination of the digestive tract on microbial biofilm formation on endotracheal tubes from artificially ventilated patients. Eur J Clinic Microbiol Infect Dis 1993;21(1):9–17.

Adair CG, Gorma SP, Byers LM, Jones DS, Feron B, Growe M, Webb HC, McCarthy GJ, Milligan KR. Eradication of endotracheal tube biofilm by nebulized gentamycin. Intensive Care Med 2002;28(4):426–31.

Karchmer TB, Giannetta ET, Muto CA, Strain BA, Farr BM. A randomized crossover study of silver-coated urinary catheters in hospitalized patients. Arch Intern Med 2000;160(21):3294–8.

Olson ME, Harmon BG, Kollef MH. Silver-coated endotracheal tubes associated associated with reduced bacterial burden in the lungs of mechanically ventilated dogs. Chest 2002;121(3):863–70.

Berra L, De Marchi L, Yu ZX, Laquerriere P, Baccarelli A, Kolobow T. Endotracheal tubes coated with antiseptics decrease bacterial colonization of the ventilator circuits, lungs, and endotracheal tube. Anesthesiology,2004;100(6):1446-56.

Kolobow T, Li Bassi G, Curto F, Zanella A. The Mucus Slurper: A novel tracheal tube that requires no tracheal tube suctioning. A preliminary report.Intensive Care Med 2006;32(9):1414–8.

Li Bassi G, Curto F, Zanella A, Stylianou M, Kolobow T. A 72 hour study to test the efficacy and safety of the “Mucus Slurper” in mechanically ventilated sheep. Crit Care Med 2007;35(3):906–11.

Coppadoro A, Berra L, Bigatello LM. Modifying endotracheal tubes to prevent ventilator-associated pneumonia. Curr Opin Infect Dis 2011;24(2):157-62.

Seegolin RD, Van Hesselt GL. Aspiration beyond endotracheal cuffs. Can Anaesth Soc 1986;33(3 Pt 1):273–9.

Oikkonen M, Aromaa U. Leakage of fluid around lowpressure tracheal tube cuffs. Anaesthesia 1997;52:567–9.

Miller MA, Arndt JL, Konkle MA, Chenoweth CE, Iwashyna TJ, Flaherty KR, Hyzy RC. A polyurethane cuffed endotracheal tube is associated with decreased rates of ventilator-associated pneumonia. J Crit Care 2011;26(3:280-6.

Poelaert J, Pieter D, Annick W. Polyurethane cuffed endotracheal tubes to prevent early postoperative pneumonia after cardiac surgery: A pilot study. J Thorac Cardiovasc Surg 2008;135(4):771-6.

Lorente M. Influence of an Endotracheal Tube with Polyurethane Cuff and Subglottic Secretion Drainage on Pneumonia. Am J Respir and Crit Care Med 2009;176(1):1079-83.

Blunt MC, Young PJ, Patil A, Haddock A. Gel lubrication of the tracheal tube cuff reduces pulmonary aspiration. Anesthesiology 2001;95(2):377-81.

DeRiso AJ 2nd, Ladowski JS, Dillon TA, Justice JW, Peterson AC. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest 1996;109(6):1556-61.

Nathens AB, Marshall JC. Selective decontamination of the digestive tract in surgical patients: a systematic review of the evidence. Arch Surg 1999;134(2):170-6.

Dullenkopf A, Gerber A, Weiss M. FLuid leakage past tracheal tube cuffs: evaluation of the new Microcuff endotracheal tube. Intensive Care Med 2003;29(10):1849-53.

Ferre M, Torres A. Maintenance of tracheal tube cuff pressure: where are the limits? Critical Care 2008; 12:106.

Valencia M, Ferrer M, Farre R, Navajas D, Badia JR, Nicolas JM, Torres A. Automatic control of tracheal cuff pressure in ventilated patients in semirecumbent position: a Nicolas JM, Torres A. Automatic control of tracheal cuff pressure in ventilated patients in semirecumbent position: a randomized trial. Crit Care Med 2007; 35: 1543-9.

Weiss M, Doell C, Koepfer N, Majdpour C, Woitzek K, Bernet V. Rapid pressure compensation by automated cuff pressure controllers worsen sealing in tracheal tubes. Br J Anesth 2009; 102: 273-8.

Young PJ, Pakeerathan S, Blunt MC, Subramanya S. A low-volume, low-pressure tracheal tube cuff reduces pulmonary aspiration. Crit Care Med 2006;34(3):632-9.

Dullenkopf A, Schmitz A, Frei M, Gerber AC, Weiss M. Air leakage around endotracheal tube cuffs. Eur J Anaesthesiol 2004;21:448-53.

Lucangelo U, Zin WA, Antonaglia V, Petrucci L, Viviani M, Buscema G, Borelli M, Berlot G. Effect of positive expiratory pressure and type of tracheal tube cuff on the incidence of aspiration in mechanically ventilated patients in an intensive care unit. Crit Care Med 2008; 36: 409-13.

Nseir S, Zerimech F, De Jonckheere J, Alves I, Balduyck M, Durocher A. Impact of polyurethane on variations in tracheal wall pressure in critically ill patients: A prospective observational study. Intensive Care Med 2010; 36: 1156-63.

Pitts R, Fisher D, Sulemanji D, Kratohvil J, Jiang Y, Kacmarek R. Variables affecting leakage past endotracheal tube cuffs: A bench study. Intensive Care Med 2010; 36(12):2066-73.

Zanella A, Scaravilli V, Isgro S, Milan M, Cressoni M, Patroniti M, Fumagalli R, Pesenti A. Fluid leakage across tracheal tube cuff, effect of different cuff material, shape, and positive expiratory pressure: a bench-top study. Intensive Care Med 2010; 37: 343-7.

Young PJ, Burchett K, Harvey I, Blunt MC: The prevention of pulmonary aspiration with control of tracheal wall pressure using a silicone cuff. Anaesth Intensive Care 2000; 28:660-5.

IssueVol 51, No 7 (2013) QRcode
Endotracheal tube Polyurethan Polyvinyl Chloride Ventilator associated pneumonia

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Mahmoodpoor A, Peyrovi-far A, Hamishehkar H, Bakhtyiari Z, Mirinezhad MM, Hamidi M, Golzari SEJ. Comparison of Prophylactic Effects of Polyurethane Cylindrical or Tapered Cuff and Polyvinyl Chloride Cuff Endotracheal Tubes on Ventilator-Associated Pneumonia. Acta Med Iran. 1;51(7):461-466.