Scientific paper
Aspiration pneumonia: Incidence of aspiration with endotracheal tubes

https://doi.org/10.1016/0002-9610(76)90181-1Get rights and content

Abstract

Aspiration has been suggested as a source of pulmonary complications seen in patients with tracheal intubation. A previous study demonstrated that the high incidence of aspiration in patients with tracheostomies can be decreased by modification of the tracheostomy tube cuff design. In the present protocol, 100 patients with endotracheal tubes in place were studied to document the incidence of aspiration and to attempt to decrease the incidence by modification of cuff design. Utilizing an Evans blue dye test to detect aspiration, 27 of the 48 patients (56 per cent) with standard low volume, high pressure cuffed tubes had positive tests. In 17 patients with modified standard cuffed tubes, the incidence of aspiration was decreased to 29 per cent (5 patients). Aspiration was further decreased to 20 per cent (7 patients) in the 35 patients with high volume, low pressure cuffed tubes. These results demonstrate that the incidence of aspiration in patients with endotracheal tubes can be decreased by modification of endotracheal tube cuff design.

References (4)

There are more references available in the full text version of this article.

Cited by (142)

  • Cuffed endotracheal tubes in infants and children: A technique to continuously measure the intracuff pressure

    2013, International Journal of Pediatric Otorhinolaryngology
    Citation Excerpt :

    These include a reduced incidence of exchange of the cuffed endotracheal tube, better airway seal providing improved respiratory mechanics, a more accurate ETCO2 tracing, and a decreased use of inhalational agents resulting in improved economics and less pollution of the operating rooms [1,4–6]. In certain intraoperative scenarios and in the ICU settings, the use of a cuffed endotracheal tube may also reduce the incidence and severity of aspiration in mechanically ventilated patients [7–9]. Despite these advantages, it has been demonstrated that the intracuff pressure should be maintained at approximately 25 cmH2O to prevent underinflation and aspiration of dye past the large-diameter, thin-walled cuff [7–10].

  • The Difficult Airway in Pediatrics

    2013, Advances in Anesthesia
    Citation Excerpt :

    The concerns regarding increased resistance of a smaller endotracheal have been virtually eliminated by the new generation of ICU ventilators, which are able to compensate for the smaller ID of cuffed endotracheal tubes by providing pressure support, thereby overcoming the increased work of breathing that they may impose. In specific intraoperative scenarios and in the ICU setting, the use of cuffed endotracheal tubes may also reduce the incidence and severity of aspiration in mechanically ventilated patients [36,37]. However, when cuffed endotracheal tubes are used, attention should be directed toward monitoring of the intracuff pressure [38].

  • Anesthesia and pain management

    2012, Oral and Maxillofacial Surgery in Dogs and Cats
  • Clinical and economic burden of postoperative pulmonary complications: Patient safety summit on definition, risk-reducing interventions, and preventive strategies

    2011, Critical Care Medicine
    Citation Excerpt :

    PP and VAP are initiated by the introduction of micro-organisms from the mouth and digestive tract into the distal airways (39, 58–60). Factors contributing to the development of PP after aspiration include the predominant organism(s), a large inoculum, and compromised host defenses (61–63). PP from other potential routes—such as hematogenous spread, contiguous spread from the pleural cavity, or infection from contaminated respiratory equipment—occurs relatively rarely (64) and is not discussed here.

View all citing articles on Scopus
1

From the Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland.

View full text