Current Issue

Endotracheal Tube Cuff Design and the Impact on Aspirations
Aryeh Shander, MD
Post-intubation pulmonary complications (PPC) remain one of the leading causes of morbidity and mortality and result in delayed discharge of post surgical patients. While several patient- and procedure-related factors have been linked to increased risk of PPCs, aspiration of upper airway secretions into the respiratory tract is a major etiologic factor. To prevent this from happening and to allow positive pressure ventilation, endotracheal tubes are equipped with inflatable cuffs that are filled after the tube is in place to provide a seal. These are either "low-volume, high-pressure" (LVHP) or "high-volume, low-pressure" (HVLP) cuffs. A problem with these cuffs is that folded cuff material often creates small longitudinal ducts and channels that permit leakage of fluids past the cuff into the respiratory tract. This leakage can result in microaspiration and plays an important role in PPC complications, including pneumonia. Several strategies to reduce and prevent microaspiration or attenuate its detrimental effects have been proposed including newer cuff designs and materials that provide a better seal, and suctioning of subglottic secretions. These and other strategies are undergoing active investigation.

Panel Discussion: Postoperative Pulmonary Complications: What are they and What are the Perioperative Risks?
Moderator: Ayreh Shander, MD
Panelists: Gerald W. Smetana, MD
Garry Brydges, DNP, CRNA, ACNP-BC
Steven Lisco, MD
Ruben Restrepo, MD, RRT
Marin H. Kollef, MD
Postoperative pulmonary complications are well-understood and documented, but opinions vary as to the definition of PCCs, their causes, who is at risk, and how to prevent them. In this panel discussion, several experts were asked to answer questions related to the definition of PCCs, their frequency, and implications for hospital length of stay and costs. Panelists discuss the risk factors for PPCs, both modifiable and non-modifiable, and present strategies to address the latter. Finally, suggestions on how to prevent microaspiration are also discussed.

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