François Philippart, Stéphane Gaudry, Laurent Quinquis, Nicolas Lau, Islem Ouanes, Samia Touati, Jean Claude Nguyen, Catherine Branger, Frédéric Faibis, Maha Mastouri, Xavier Forceville, Fekri Abroug, Jean Damien Ricard, Sophie Grabar, and Benoît Misset Am. J. Resp. Crit. Care Med. Mar 15, 2015; vol. 191, no. 6: 637-645
Rationale: The occurrence of ventilator-associated pneumonia (VAP) is linked to the aspiration of contaminated pharyngeal secretions around the endotracheal tube. Tubes with cuffs made of polyurethane rather than polyvinyl chloride or with a conical rather than a cylindrical shape increase tracheal sealing.
Objectives: To test whether using polyurethane and/or conical cuffs reduces tracheal colonization and VAP in patients with acute respiratory failure.
Methods: We conducted a multicenter, prospective, open-label, randomized study in four parallel groups in four intensive care units between 2010 and 2012. A cohort of 621 patients with expected ventilation longer than 2 days was included at intubation with a cuff composed of cylindrical polyvinyl chloride (n = 148), cylindrical polyurethane (n = 143), conical polyvinyl chloride (n = 150), or conical polyurethane (n = 162). We used Kaplan-Meier estimates and log-rank tests to compare times to events.
Measurements and Main Results: After excluding 17 patients who secondarily refused participation or had met an exclusion criterion, 604 were included in the intention-to-treat analysis. Cumulative tracheal colonization greater than 103 cfu/ml at Day 2 was as follows (median [interquartile range]): cylindrical polyvinyl chloride, 0.66 (0.58–0.74); cylindrical polyurethane, 0.61 (0.53–0.70); conical polyvinyl chloride, 0.67 (0.60–0.76); and conical polyurethane, 0.62 (0.55–0.70) (P = 0.55). VAP developed in 77 patients (14.4%), and postextubational stridor developed in 28 patients (6.4%) (P = 0.20 and 0.28 between groups, respectively).
Conclusions: Among patients requiring mechanical ventilation, polyurethane and/or conically shaped cuffs were not superior to conventional cuffs in preventing tracheal colonization and VAP.