Mechanical influences on fluid leakage past the tracheal tube cuff in a benchtop model

Purpose High-volume low-pressure (HVLP) cuffs on endotracheal tubes do not fully protect the lower airway from leakage of potentially contaminated secretions down the longitudinal folds within the cuff. Here, our purpose was to evaluate potential effects of positive end-expiratory pressure (PEEP), inspiratory effort intensity, and tube characteristics on fluid leakage past the cuff. Methods This benchtop study at a research laboratory used a tracheal tube inserted into an artificial Plexiglas trachea connected to a ventilator and lung model. Methylene blue was deposited above the tube cuff to simulate subglottic secretions. Five PEEP levels (0, 5, 10, 15, and 20 cmH 2 O) were tested with volume-controlled ventilation and three simulated inspiratory effort levels with pressure-support ventilation. Several cuff materials and tube sizes were tested. Results The leakage occurrence rate ranged from 91% with zero PEEP to 8% with 15 and 20 cmH 2 O PEEP and was indirectly proportional to the PEEP level with significant correlation ( R 2 = 0.39, p