Pulmonary aspiration in mechanical ventilation occurs despite appropriate inflation of the tracheal tube cuff. After anaesthesiath is can causep ostoperative and, in critically ill patients, ventilator-associated pneumonia. Cuff over-inflation exerts excessive pressure on the tracheal mucosa causing injury. High volume low pressure (HVLP) cuffs permit wall pressure control as the intracuff pressure (CP) is the tracheal wall pressure (TWP). Unfortunately, at the cuff wall, folds and channels and, therefore, fluid leakage occur. Low volume high pressure (LVHP) cuffs develop neither folds nor associated leakage, but TWP is not easily inferred from CP and excessive pressures can result in tracheal injury. This thesis examines the problem of aspiration in a model, in anaesthetised patients and in the critically ill. In the model, protection against leakage resulted from positive end-expiratory pressure and cuff lubrication. Two tracheal cuff prototypes are introduced. Firstly, the compliant HVLP cuff is one with a tapered shape made of highly compliant material. Within the model this produced a circumferential band at the cuff wall without folds thus effectively eliminating channels and leakage. Secondly, the prototype pressure limited cuff (PLC) is a latex LVHP cuff with inflation characteristics such that TWP can be inferred from CP and maintained at an acceptable level. Within the model the PLC prevented leakage at acceptable TWPs. For clinical use a constant pressure inflation device is required to provide uninterrupted protection, although notably HVLP cuffs allow leakage despite this. The PLC prevented dye aspiration in 100% of tracheally intubated critically ill patients compared with 13% of the control HVLP group (p<0.01). A silicone cuff with similar inflation characteristics, yet improved biocompatability and shelf life, prevented dye aspiration in 100% of patients with tracheostomies compared to 0% of the HVLP control group (p=0.001). HVLP cuff lubrication delayed dye aspiration for 1 to 5 days (p<0.05).
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:323263 |
| Date | January 1999 |
| Creators | Young, Peter Jeffrey |
| Publisher | University of East Anglia |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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